AIM: To explore the factors affecting the whole-eye astigmatism after pterygium excision combined with autologous limbal stem cell transplantation.METHODS: A retrospective analysis was conducted on the medical records of 42 patients(42 eyes)with primary pterygium admitted in the ophthalmology department of Xijing Hospital from January 2023 to October 2023. They underwent pterygium excision combined with autologous limbal stem cell transplantation. The maximum invasion depth of pterygium into the cornea was measured with anterior segment optical coherence tomography(AS-OCT)before operation, the length of the pterygium invading cornea, the width of the limbus and the area of the invading cornea were measured during the operation, and three-dimensional values of corneal astigmatism of anterior segment, index of surface variance(ISV), index of vertical asymmetry(IVA), best corrected visual acuity(BCVA)and whole-eye astigmatism were collected before and at 1 mo after surgery. Patients with astigmatism ≤0.50 D or >0.50 D of the whole eye at 1 mo after surgery were assigned to group A and B, respectively. The differences of clinical data before and at 1 mo after surgery between the two groups, and the correlation between pre-operative clinical indicators and whole-eye astigmatism were analyzed. The decision tree algorithm was performed to explore the influencing factors of whole-eye astigmatism at 1 mo postoperatively.RESULTS: The maximum invasion depth of pterygium in the group A was significantly less than that in the group B [80.00(40.00, 180.00)μm vs 175.00(123.00, 190.00)μm, P=0.002]. Preoperative BCVA(LogMAR), whole-eye astigmatism, cornea astigmatism, ISV, IVA and maximum invasion depth of pterygium were positively correlated with whole-eye astigmatism at 1 mo after surgery(rs=0.317, P=0.041; rs=0.545, P<0.001; rs=0.448, P=0.003; rs=0.389, P=0.011; rs=0.382, P=0.013; rs=0.391, P=0.010). The decision tree algorithm screened out two influential factors: the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. The risk of whole-eye astigmatism >0.50 D at 1 mo after operation was higher with maximum invasion depth of pterygium into the cornea >95 μm than that with ≤95 μm. Among the patients with whole-eye astigmatism >2.63 D before operation, the probability of residual whole-eye astigmatism >0.50 D was 88.9%, and the predictive model AUC was 0.804.CONCLUSION: The whole-eye astigmatism after pterygium resection is mainly affected by the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. When the maximum invasion depth of pterygium into the corneal is >95 μm and the whole-eye stigmatism is >2.63 D before surgery, the patient should receive surgical treatment as soon as possible in order to obtain good clinical benefits.

BACKGROUND: Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery. METHODS: PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed. RESULTS: PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model. CONCLUSIONS: The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes. TRIAL REGISTRATION ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Algorithms ; Lung Diseases/etiology* ; Machine Learning ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications/diagnosis* ; Risk Factors ; ROC Curve

Objective To investigate the relationship between exposure to foodborne antibiotics and gut microbiota,as well as its impact on irritable bowel syndrome(IBS).Methods A total of 100 IBS patients(IBS group)and 100 healthy controls(control group)were enrolled in this case-control study.Antibiotic ex-posure was assessed by serum detection,and gut microbiota composition was analyzed by 16S rRNA gene se-quencing technology.Binary Logistic regression model and chi-square test were used for statistical analysis to explore the relationship between antibiotic exposure and IBS,and to analyze the differences in gut microbiota.Results The antibiotic exposure rate of IBS group was significantly higher than that of control group(59％vs.36％,P=0.016),and the exposure to β-lactam antibiotics was significantly different between the two groups(P=0.047).In addition,the composition of gut microbiota in the IBS group was significantly different from that in the control group,and the abundance of Firmicutes was increased(P＜0.001),while the abun-dance of Lactobacillus,Bifidobacterium and Faecalibacterium was decreased(P＜0.001).Conclusion Food-borne antibiotic exposure may be one of the risk factors for IBS,and antibiotic exposure may affect the occur-rence and development of IBS by changing the composition of gut microbiota.Foodborne antibiotic exposure may be a risk factor for inducing IBS and could affect the disease process by altering the structure of the gut microbiota.Therefore,enhancing the regulation of foodborne antibiotic use and raising public awareness about the importance of minimizing foodborne antibiotic exposure can effectively prevent and reduce the incidence of IBS.

Objective To investigate serum vitamin D levels of healthy children in Beijing and to analyze the factors affecting vitamin D level.Methods Healthy children aged 1-14 years old who underwent physical examination in department of pediatrica,Civil Aviation General Hospital from September 2016 to September 2020 were randomly selected as research objects.Clinical data of the children were collected and a questionnaires survey was conducted.The level of 25-hydroxy vitamin D[25-(OH)D]was detected by liquid chromatography-tandem mass spectrometry.Serum 25-(OH)D levels were compared between different groups(grouped by age,gender,season,outdoor activity time,and vitamin D supplementation).Results A total of 990 children met the inclusion criteria.There were 500 boys and 490 girls,with a mean age of(6.42±3.50)years old.The mean serum level of 25-(OH)D was(28.23±6.74)ng/ml in all the selected children(range,11.70-51.90 ng/ml),(31.99±6.47)ng/ml in young child group,(27.54±6.49)ng/ml in preschool group,and(25.84±5.93)ng/ml in school-age group.The serum level of 25-(OH)D in the young child group was significantly higher than those in the preschool group and school-age group(P<0.05).There was no significant difference in the serum level of 25-(OH)D between the preschool group and school-age group(P>0.05).There were significant differences in the proportions of children with normal 25-(OH)D,insufficient 25-(OH)D and deficient 25-(OH)D among different age groups(P<0.05).There was no significant difference in the serum level of 25-(OH)D between boys and girls in the same age group(P>0.05).There was significant difference in 25-(OH)D levels among different age groups with a same gender(P<0.05).There was no significant difference in the proportions of children with normal 25-(OH)D,insufficient 25-(OH)D,or deficient 25-(OH)D between boys and girls(P>0.05).The level of serum 25-(OH)D and the proportion of children with normal serum 25-(OH)D reached the highest in summer and the lowest in winter.There were significant differences in the serum 25-(OH)D levels and the proportion of children with normal serum 25-(OH)D among different seasons(P<0.05).The serum 25-(OH)D level in children with outdoor activities≥1 h daily was significantly higher than that in children with outdoor activities<1 h daily(P<0.05).There were significant differences in the proportions of normal 25-(OH)D,insufficient 25-(OH)D and deficient 25-(OH)D between children with outdoor activities≥1 h daily and children with outdoor activities<1 h daily(P<0.05).The serum levels of 25-(OH)D in children of never-supplement group and sometimes-supplement group were lower than that in the daily supplement group(P<0.05),and there were significant differences in the proportions of normal 25-(OH)D,insufficient 25-(OH)D and deficient 25-(OH)D among the three groups(P<0.05).Conclusion Vitamin D nutritional status of healthy children in Beijing is good.Serum 25-(OH)D level decreases with age.No difference is found in the serum 25-(OH)D level between boys and girls in every age group.No abnormal vitamin D level is found in young children.The insufficiency and deficiency of vitamin D exist in preschool and school-age children,which needs to be improved.Vitamin D level in children is related to seasons.Sufficient time of outdoor activities and regular supplementation of vitamin D can help improve vitamin D nutritional status in children.

Objective To investigate the diagnostic value of electromyographic(EMG)tremor indicators for Parkinson's disease(PD)using the Logistic regression model.Methods A total of 65 patients with PD(PD group)and 39 patients with essential tremor(ET)(ET group)were enrolled and underwent EMG tremor analysis.General information,disease-related data,and EMG tremor characteristics were compared between the two groups.Multivariate Logistic regression analysis was performed to screen for independent influencing factors of PD,and receiver operating characteristic(ROC)curves were plotted.The area under the curve(AUC)was used to evaluate the diagnostic value of EMG tremor indicators for PD.Results Compared with the ET group,the PD group had a higher proportion of patients with unilateral onset and those with tremor spectrum frequency≥2 times,and a lower proportion of patients with a family history of tremor(P＜0.05).The tremor peak frequencies in the resting,postural,and weight-bearing(1 000 g)states were lower in the PD group than in the ET group(P＜0.05).There were statistically significant differences in the tremor rhythm patterns between the two groups in the resting and weight-bearing states(P＜0.05),with the PD group dominated by alternating contraction patterns and the ET group by synchronous contraction pat-terns.Multivariate Logistic regression analysis revealed that the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum were independent influencing factors of PD(P＜0.05).The ROC curves showed that the AUCs of the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum for diagnosing PD were 0.886,0.750,and 0.779,respec-tively.The combination of these three indicators yielded the highest AUC(0.936)for diagnosing PD,with a sensitivity of 81.54％and a specificity of 94.87％.Conclusion The tremor peak fre-quency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum provided by EMG tremor analysis can serve as clinical indicators for early diagno-sis of PD,and their combined use offers higher diagnostic value,which can be used to differentiate PD from ET.

Objective To profile ubiquitination in cysteinyl aspartate-specific proteinase-2(CASP2)deficient cells under heat shock and investigate the role of CASP2 in stress response.Methods Ubiquitination levels in subcellular fractions of control and C ASP2 knockout(KO)cells were detected via Western blotting.After 2 hours of heat shock treatment,Soluble Ⅱ and Pellet fractions were collected from both control and CASP2 KO cells for ubiquitinome analysis.Anti-di-glycine remnant(K-ε-GG)antibody-based proteomic analysis was performed to identify differentially ubiquitinated proteins and associated key signaling pathways.Proteins that displayed significantly upregulated ubiquitination in CASP2 KO cells under heat shock were subjected to His-tag pull-down assays to find out whether CASP2 regulated the ubiquitination of these proteins.Results Under heat shock,CASP2 KO cells displayed significantly higher accumulation of overloaded ubiquitinated conjugates in the Pellet fraction compared to controls.Ubiquitinomics analysis revealed substantial alterations in protein ubiquitination patterns following CASP2 KO.One hundred proteins exhibited significantly elevated ubiquitination levels while 36 proteins had their ubiquitination reduced relative to controls.Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis indicated that hyper-ubiquitinated proteins were primarily associated with Huntington disease,Alzheimer disease,bile secretion,carbon metabolism and autophagy.His-tag pull-down assays combined with Western blotting revealed increased ubiquitination of nicotinamide adenine dinucleotide reduced-ubiquinone oxidoreductase 1 beta subcomplex subunit 3(NDUFB3)and autophagy-related protein 9A(ATG9A)in CASP2 KO cells under heat shock.Conclusion Overloaded ubiquitinated conjugates are accumulated due to CASP2 deficiency during heat shock.CASP2 modulates ubiquitination levels through multiple signaling pathways.

Objective·To investigate the effect of ceria nanoparticles-polyethylene glycol(CeNP-PEG)on scavenging reactive oxygen species(ROS)and alleviating disease activity in dextran sulphate sodium(DSS)-induced colitis mice.Methods·CeNP was synthesized with the hydrates of cerium acetate,oleamine,and xylene,which was modified with polyethylene glycol-stearyl phosphatidylethanolamine(mPEG-DPSE)to obtain CeNP-PEG.Then CeNP-PEG was purified.The particle size and zeta potential of CeNP-PEG were measured by using transmission electron microscopy(TEM)and dynamic light scattering(DLS).Mouse macrophages(Raw264.7)were cultured in vitro and induced to a pro-inflammatory phenotype(M1 phenotype).M1 macrophages were treated with 0.5 μg/mL and 1.0 μg/mL CeNP-PEG,respectively,and then Western blotting was used to detect the expression changes of the proteins related with nuclear factor-κB(NF-κB)signaling pathway.DSS-induced colitis mice models were constructed,and CeNP-PEG(1.0 mg/mL)was intravenously administrated for 3 times via tail vein during the modeling period.Meanwhile,the body weight,fecal characteristics,and frequency of rectal bleeding in mice were monitored in the normal control group(Normal group),the model group(DSS group),and the CeNP-PEG treatment group.The disease activity index(DAI)was calculated to evaluate the intestinal inflammation.The level of ROS in mouse intestinal tissues was detected by dihydroethidine(DHE)staining and the mRNA expression levels of inflammatory cytokines interferon-γ(Ifn-γ),interleukin-6(Il-6),Il-1β and tumor necrosis factor-α(Tnf-α)were detected by real-time quantitative PCR(RT-qPCR).Results·The hydrated particle size of synthesized CeNP-PEG was(6.96±0.27)nm,and the average zeta potential was(-6.02±1.31)mV.Western blotting results showed that the expression of p-P65 increased in the pro-inflammatory macrophages compared with the control group.The expression of NF-κB inhibitor-α(IκB-α)decreased,and their expressions tended to recover after the intervention of different concentrations of CeNP-PEG.In the DSS-induced colitis models,mice in the CeNP-PEG treatment group lost less weight than those in the DSS group(P= 0.000)and had lower DAI scores(P=0.000).The RT-qPCR results of intestinal tissues showed that the mRNA levels of Ifn-γ,Il-1β,Il-6 and Tnf-α in the DSS group were significantly up-regulated compared with those in the Normal group(P=0.000),and all of them significantly decreased in the CeNP-PEG treatment group.The results of DHE staining showed that the fluorescence intensity of intestinal tissues in the DSS group was significantly enhanced than that in the Normal group,and the fluorescence intensity decreased in the CeNP-PEG treatment group.Conclusion·CeNP-PEG can inhibit the expression of intestinal inflammatory factors and the activation of NF-κB-related inflammatory pathway of pro-inflammatory macrophages,eliminate intestinal ROS,improve the intestinal inflammatory microenvironment,and alleviate the disease activity of DSS-induced colitis in mice.

AIM:To investigate the differences in clinical features and therapeutic effects of the tea tree oil wipes combined with deep massages of the meibomian glands for different age groups of patients with demodex blepharitis.METHODS:The clinical data of 146 patients(292 eyes)diagnosed with demodex blepharitis, hospitalized in Department of Ophthalmology, Xijing Hospital from January 2023 to October 2023, was collected in this retrospective study, and the patients were divided into group A(64 cases with 128 eyes)aged ≤45 years old and group B(82 cases with 164 eyes)aged >45 years old according to different ages. The differences in total numbers of binocular mites, Schirmer I tests, symptom and sign scores before, and at 1 and 3 mo after the treatment of the tea tree oil wipes combined with deep massages of the meibomian glands were analyzed between the two groups.RESULTS: Before the treatments, the total number of the mites in the group A [7(6, 8)] was lower than that in the group B [8(7, 9.25); P<0.05]. The dry eye score in the group A [6(6, 7)] was lower than that in the group B [11(10, 12); P<0.001], and the ocular surface irritation symptom score in the group A [10(9, 11)] was higher than that in the group B [6(6, 7); P<0.001]. Both groups experienced a decrease in mite counts and improvement in symptoms and signs scores at 1 mo after treatment, and there was still a degree of improvement in all clinical indicators, with patients in the group B showing a further reduction in mite counts [-1(-3, 0)] even after the treatment was continued for 3 mo.CONCLUSION:The total numbers of mites in patients of older than 45 years old were higher than those in patients of ages younger than 45, and older patients have more serious dry eyes, with less serious symptoms of ocular surface irritation. The treatment can effectively reduce the number of mites in patients of different ages with demodex blepharitis, but the outcomes of Schirmer I tests do not change after the treatment. Longer treatment duration provide sustained clinical benefits.

AIM:To observe the clinical efficacy of 3% diquafosol sodium eye drops combined with sodium hyaluronate eye drops in the treatment of dry eyes after pterygium surgery with lacrimal insufficiency.METHODS: A total of 64 cases(64 eyes)of pterygium patients with lacrimal insufficiency were treated with pterygium resection combined with limbal stem cell transplantation, and they were given routine anti-inflammatory and infection prevention treatment postoperatively. In terms of postoperative dry eye treatment, all patients were randomly divided into two groups. The observation group was treated with 3% diquafosol sodium eye drops combined with sodium hyaluronate eye drops, and the control group was treated with sodium hyaluronate eye drops. The break-up time of tear film(BUT), fluorescein(FL), Schirmer's Ⅰ test(SⅠt), ocular surface disease index(OSDI)score, central corneal thickness(CCT)changes, adverse reactions and complications were observed and compared between the two groups at different times postoperatively.RESULTS: Both groups of pterygium patients were accompanied with mild to moderate dry eyes with insufficient tear secretion preoperatively. At 2 wk after operation, both groups showed shorter BUT and higher FL score compared with those preoperatively(P<0.05). There was no significant difference between the two groups(P>0.05). At 4 wk after operation, BUT in the observation group was prolonged, OSDI score was decreased(both P<0.05), and FL score in both groups was decreased compared with those at with 2 wk after operation(P<0.05). The observation group was better than the control group(P<0.05). At the first day after operation, the CCT of the two groups was thicker than that preoperatively(P<0.05), and there was no significant difference in SⅠt between the two groups before and after operation(P>0.05).CONCLUSION: In the treatment of dry eye after pterygium surgery with lacrimal insufficiency, 3% diquafosol sodium eye drops combined with sodium hyaluronate eye drops can effectively reduce the postoperative dry eye symptoms, and its clinical effect is better than that of sodium hyaluronate eye drops alone.

Objective:To explore the feasibility of long board detector of digital radiography(DR)in clinical application.Methods:The long board detector(detector)was erected and placed upright.The scale long ruler with marked metal lead wire was placed at 20 cm in front of the center of long axis of the board of detector,which paralleled medial axis.Three test cards of spatial resolution were respectively placed at three positions(upper,middle and lower)of detector,and they were stuck on the board of detector as 30cm intervals between each other and 45° position.The exposures were conducted at 100,150,and 200 cm of source image distance(SID).The incident doses were tested,which obtained from different SID spots of upper,middle and lower positions of detector.The spatial resolutions of 3 positions were determined through observed the images of cards.The ratio of the marked scale length with metal lead wire to actual length of lead wire was measured through the projection of the scale length,so as to obtain the amplification rate of different spot positions.The spatial distribution of effective focal plane on the direction of long axis of detector,and the morphological change of that were observed.Results:When SID spots were respectively 100,150 and 200cm,the amplification rates of images decreased with increasing SID.The difference of amplification rates among three SID spots was significant(F=223.80,P<0.001).There was significant difference in the corresponding radiation doses among different SID spots(F=7.57,P<0.05).The spatial resolution was constantly 1.8 LP/mm.There was heel effect along with the direction of short axis of detector.The effective focal spot on the direction of long axis of detector appeared up-down symmetrical display.Conclusion:The long board detector of DR equipment has realized the capture for the images of the overall length of spine or the overall length of lower limbs in one exposure,which can meet the clinical requirement,and improve the detection efficiency of X-ray.