OBJECTIVES: To compare the efficacy of toric implantable collamer lens (Toric-ICL) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia correction in patients with moderate to high myopia complicated with astigmatism. METHODS: We retrospectively collected data from 64 patients (aged 18-42 years) with moderate to high myopia complicated with astigmatism (128 eyes) undergoing either Toric-ICL (28 patients/56 eyes) or FS-LASIK (36 patients/72 eyes) at our department between January, 2019 and December, 2020. The changes of uncorrected distance visual acuity (UCVA), spherical equivalent (SE), mean astigmatism correction index (CI), corneal endothelial cell density (ECD) and intraocular pressure (IOP) following the procedures were compared between the two groups. RESULTS: In FS-LASIK group, all the eyes (72/72) achieved an UCVA≥1.0, similar to the rate in Toric-ICL group (55/56 eyes; P=0.2374). The postoperative SE was also comparable between FS-LASIK and Toric-ICL groups [0.43±0.06 D (range: -1.0 to 1.50 D) vs 0.38±0.05 D (range: -0.75 to 1.00 D); P=0.56]. The mean astigmatism CI was significantly higher in FS-LASIK group than in Toric-ICL group (0.8561 vs 0.7176; P<0.0001), and 88.89% of the eyes in FS-LASIK group and 69.64% in Toric-ICL group had postoperative astigmatism ≤0.50 D. No significant changes were observed in postoperative corneal ECD in FS-LASIK group, whereas ECD decreased significantly after the procedure in Toric-ICL group (P=0.0057). The patients undergoing Toric-ICL exhibited no significant changes of postoperative IOP, but the patients receiving FS-LASIK had significantly reduced IOP after the procedure (P<0.001). CONCLUSIONS Although the patients included in Toric-ICL group had higher myopia and astigmatism, Toric-ICL still showed better predictability and efficacy for astigmatic correction in Toric-ICL group. Toric-ICL is an effective and safe equivalent of FS-LASIK for correcting moderate myopia but can be more advantageous for correcting high myopia with astigmatism.
Humans ; Astigmatism/complications* ; Myopia/complications* ; Keratomileusis, Laser In Situ/methods* ; Retrospective Studies ; Adult ; Visual Acuity ; Adolescent ; Young Adult ; Treatment Outcome ; Male ; Lens Implantation, Intraocular/methods* ; Female ; Phakic Intraocular Lenses ; Intraocular Pressure

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Objective:To study the clinical characteristics and death risk factors of the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020.Methods:The clinical data were retrospectively analyzed of the 894 patients with fall-related injuries who had been admitted to Department of Trauma Center, The First People's Hospital of Kashgar Prefecture, Xinjiang Uygur Autonomous Region from January 2019 to December 2020. Recorded were the patient's gender, age, location of fall, month of fall, fall height, major injury site, injury severity score (ISS) and Glasgow score (GCS). The clinical characteristics and death risk factors of the fall patients were analyzed.Results:Of the 894 patients, 72.3%(646/894) were male and 86.9%(777/894) fell from a height from 1 to 6 meters. Their ages ranged mainly from 15 to 59 years old (74.3%, 664/894). Home was the most frequent site for falls (60.2%, 538/894) and the patients who fell in summer months (from June to August) were the most (32.3%, 289/894). Twenty-one patients (2.3%, 21/894) died. There were significant differences in the major injury site, blood transfusion, ISS score and GCS score between the dead and survival patients ( P<0.05). The multivariate logistic regression analysis showed that the injury to the head, face and neck [ OR=10.936, 95% CI: 1.177 to 101.627, P=0.035] and GCS score ≤12 [ OR=5.640, 95% CI: 2.658 to 11.968, P< 0.001] were the death risk factors for the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020. Conclusions:In the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020, males aged from 15 to 59 years old were the high-risk group of falls. Months with a high incidence of falls were from June to August. The fall patients with injuries to the head, face and neck and with a GCS score of ≤12 were at a high risk of death.

Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder mainly caused by homozygous deletions that include exon 7 of the survival motor neuron 1 (SMN1) gene. A nearby paralog gene, SMN2, obstructs the specific detection of SMN1. We optimized a duplexed real-time PCR approach using locked nucleic acid (LNA)-modified primers to specifically detect SMN1. Methods: An LNA-modified primer pair with 3´ ends targeting SMN1 specific sites c.835-44g and c.840C was designed, and its specificity was examined by real-time PCR and Sanger Sequencing. A duplexed real-time PCR approach for amplifying SMN1 and control gene albumin (ALB) was developed. A randomized double-blind trial with 97 fresh peripheral blood samples and 25 dried blood spots (DBS) was conducted to evaluate the clinical efficacy of the duplexed approach. This new approach was then used to screen 753 newborn DBS. Results: The LNA-modified primers exhibited enhanced specificity and 6.8% increased efficiency for SMN1 amplification, compared with conventional primers. After stabilizing the SMN1 test by optimizing the duplexed real-time PCR approach, a clinical trial validated that the sensitivity and specificity of our new approach for detecting SMA patients and carriers was 100%. Using this new approach, 15 of the screened 753 newborns were identified as carriers via DBS, while the rest were identified as normal individuals. These data reveal a carrier rate of 1.99% in Hunan province, South Central China. Conclusions We have developed a novel, specific SMN1 detection approach utilizing real-time PCR with LNA-modified primers, which could be applied to both prenatal carrier and newborn screening.

Objective: To investigate the effect of adding glutathion(GSH) to tumescent solution on autologous fat graft survival. Methods: 14 male and female New Zealand rabbits were divided into experimental group and control group randomly, 7 in each group. Experimental group: The donor areas of the rabbits were injected with 3 ml of tumescent solution with GSH. Control group: The donor areas of the rabbits were injected with 3 ml regular tumescent solution. DCFH-DA probe was used for fluorescent staining of harvested fat cells. Then stained fat cells were measured for the intracellular reactive oxygen species(ROS)content by fluorescence microplate. The grafts were harvested at 3 months after transplantation and assessed by general observation, volume measurement, wet weight measurement, HE staining for the number of fat cells, and CD34 immunohistochemical staining for the measurement of micro-vascular density. T test was performed by using SPSS 24.0. Results: The intracellular ROS content of harvested fat cells in experimental group was lower than that in control group, and the difference was statistically significant (P<0.05). At 3 months after transplantation, the wet weight of fat grafts in experimental group was (1133.21±87.97) mg and that in control group was (718.79±79.27) mg. The volume of fat grafts in experimental group was (1.00±0.04) ml and that in control group was (0.59±0.03) ml. The number of fat cells in experimental group was (746.6±15.7)/10 high magnification vision and that in control group was (350.1±32.4)/10 high magnification vision. The density in group experimental was (8.1±2.0)/high magnification vision and that in control group was (6.7±2.4)/high magnification vision. The grafts′ volume, wet weight, and the number of fat cells in experimental group were higher than those in control group, and the differences were statistically significant (P<0.05). The difference of micro-vascular density between experimental group and control group had no statistical significance (P>0.05). Conclusions The addition of GSH to tumescent solution optimizes the process of autologous fat harvest, thereby improving the survival of fat graft.

Objective To investigate the frequency of NPM1 mutation and its clinical significance in patients with cytogenetically normal acute myeloid leukemia (CN-AML). Methods The data of 190 patients with CN-AML were collected from Department of Hematology, Tongji Hospital between January 2008 and June 2015, and the discrepancies in clinical features and efficacy between CN-AML patients with NPM1 mutation and those without NPM1 mutation were also analyzed. Results Among the 190 CN-AML patients, NPM1 mutation was found in 44 patients (23.16 %). The proportion of bone marrow blast cells and the count of peripheral white blood cells in patients with NPM1 mutation were higher than those in patients without NPM1 mutation (75.82 % vs. 63.87 % , P <0.05; 75.7 ×109/L vs. 60.0 ×109/L, P <0.05). The rate of response (complete remission + partial remission) in patients with NPM1 mutation was also higher than that in patients without NPM1 mutation [70.09 %(22/31) vs. 56.91 %(45/79), P<0.05) ]. Conclusion NPM1 mutation is associated with higher tumor burden and higher remission rate in CN-AML patients.

BACKGROUND: Breast cancer is the most common type of cancer in females. Aberrant expression of microRNA-21 (miR-21) has previously been reported in breast cancer tissue. The aim of this study was to investigate expression levels of serum miR-21 in breast cancer patients and evaluate its prognostic value in Chinese females. METHODS: Real-time quantitative (RQ)-PCR was used to analyze miR-21 expression in archived serum, tumor tissue, and adjacent normal tissue from 549 participants (326 with breast cancer, 223 without breast cancer). We also analyzed associations between serum miR-21 expression and breast cancer subtypes and patient prognosis. Recurrence and survival were analyzed by using the multivariate Cox proportional hazards model. RESULTS: Expression of miR-21 was significantly higher in breast cancer tissues compared with normal adjacent breast tissues (P<0.001). The 2(-DeltaDeltaCt) values for serum miR-21 in breast cancer patients versus healthy controls were 9.12+/-3.43 and 2.96+/-0.73, respectively. Multivariate Cox proportional hazards model suggested that serum miR-21 expression was an independent poor prognostic factor for both recurrence (hazard ratio [HR]= 2.942; 95% confidence interval [CI]=1.420-8.325; P=0.008) and disease-free survival (HR=2.732; 95% CI=1.038-7.273, P=0.003) in breast cancer. CONCLUSIONS: Increased serum miR-21 expression level was correlated with poor prognosis of breast cancer patients, indicating that serum miR-21 may be a novel prognostic marker for recurrence and survival of breast cancer patients before resection.
Biomarkers, Tumor/genetics ; Breast/metabolism ; Breast Neoplasms/metabolism/mortality/*pathology ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; MicroRNAs/*blood ; Neoplasm Recurrence, Local ; Prognosis ; Proportional Hazards Models ; Real-Time Polymerase Chain Reaction

Objective To analyze clinical and genetic risk factors of refractory or relapsed acute myeloid leukemia (AML) patients,and evaluate the efficacy of reinduction of chemotherapy.Methods 296 newly diagnosed AML patients,including 89 refractory or relapsed cases,were observed with clinical characteristics.And the efficiency of different reinduction chemotherapy regimens were compared.Results Compared with the non-refractory or relapsed AML,age,complex karyotype and Fms like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) gene mutations were risk factors of relapsed or refractory AML (P ＜ 0.05).Seventy-eight refractory and relapsed AML patients received reinduction therapy.The overall response rate (the complete response rate and the partial response rate) was 44.90 ％ (30/78).All reinduction regimens were divided into three categories:using the initial induction scheme or using new induction scheme including some chemotherapeutics without cross-resistance (regimen A),using the induction regimen containing medium-or high-dose cytarabine (regimen B),and using priming regimen containing of G-CSF,cytarabine,aclacinomycin or homoharringtonine (regimen C).Their overall response rate were 35.12 ％ (13/37),61.90 ％ (13/21) and 45.00 ％ (9/20),respectively,in which the overall response rate of regimen B was statistically higher than regimen A (P ＜ 0.05).Conclusions Age,complex karyotype and FLT3-ITD mutation were important causes of relapsed or refractory AML.The overall response rates were different among three different reinduction regimens.It is helpful to improve the overall response rate of reinduction therapy to use the regimen containing medium-or high-dose cytarabine,which was more suitable for young patients.For patients with poor tolerance,the priming regimen suit was more helpful to improve the overall response rate.

Objective To observe the effects of botulinum toxin A(BTX-A) injection combined with treadmill training on motor and gastrocnemius function in rats after spinal cord injury (SCI),so as to develop a possible treatment.Methods A total of 48 female Sprague-Dawley rats were randomly divided into four groups(n =12 in each):a control group which received normal saline injection(group Con-NS),an exercise group with normal saline injection(group Ex-NS),the other control group with BTX-A injection(group Con-BTX)and an exercise group which also received BTX-A injection(group Ex-BTX).All rats were subjected to incomplete SCI modelling using Allen's method.Each group then had l0 members left because of death or significant weight loss.After SCI modelling,BTX-A or normal saline were injected to rats' gastrocnemius,followed by weight support treadmill training(BWSTT) on days 7 through 35 days for the two exercise groups.Motor function was evaluated using inclined plane test before and 2 days,1,2,3,4 and 5 weeks after the injury.All rats were sacrificed 35 days after the surgery.Digit Abduction Scoring(DAS) and electrophysiological testing were performed prior to sacrifice,and the general form and the wet weight of gastrocnemius were observed after resection.Results No significant differences in the inclined plane angle among 4 groups were detected before injury and 2 days afterward (P ＞ 0.05).At the 2nd-Sth week,however,the inclined plane angles in group Ex-NS were significantly higher than those in group Con-NS (P ＜ 0.05).Those of group Ex-NS were also significantly higher than group Ex-BTX 2-5 weeks after injury (P ＜ 0.05).No significant differences were detected between group Con-BTX and group Ex-BTX,as well as group Con-NS and group Ex-BTX at each time point (P ＞ 0.05).And the average DAS score in group Con-BTX and group Ex-BTX was 0,while that of Con-NS group and group Ex-NS were both 4.There were no significant differences between the two normal saline injection groups (P ＜ 0.05),nor between the two BTX-A injection groups (P ＜ 0.05).However,the average DAS scores in the Con-BTX and Ex-BTX groups were significantly higher than the Con-NS and Ex-NS groups (P ＜ 0.05).No significant atrophy of gastrocnemius muscles were observed in the Con-NS group or Ex-NS group,and as would be expected,the muscles in group Ex-NS were thicker on average than those in group Con-NS.Significant atrophy was observed in group Con-BTX and group Ex-BTX.Moreover,the muscle wet weight was significantly higher in group ExNS than group Con-NS (P ＜ 0.05).Compared with group Con-NS and group Ex-NS,the muscle wet weight was significantly lower in group Con-BTX and group Ex-BTX (P ＜ 0.05).No significant differences in the latency of the compound muscle action potential (CAMP) were detected among 4 groups (P ＞0.05),but the CAMP amplitude was significantly less in the control groups than in the exercise groups.(P ＜0.05).Conclusions Exercise training can significantly improve motor and skeletal muscle function in SCI rats,but BTX-A injection can inhibit the improvement.