Objective To systematically analyze the medical radiation exposure levels in a district of Ningbo City and to provide a scientific basis for the reasonable and effective control of medical radiation exposure. Methods Based on the radiological diagnosis frequency and dose information system, basic medical radiation exposure data were collected, such as radiation doses received by patients in various X-ray diagnostic examinations, from all 13 public medical institutions in a district of Ningbo City from January 1 to December 31, 2020. The data were analyzed for the percentage and collective effective dose of various diagnostic examinations, the distribution of examinations by sex and age, and the number of patients undergoing two or more examinations and their cumulative doses within multiple time intervals. Results Among medical X-ray diagnostic examinations in the district, the percentages of CT examination and routine photography examination were 50.88% and 47.93%, respectively, and the collective effective dose of CT examination accounted for 97.75%. By age and sex, the frequency of examination was the highest in the age group of 45-54 years, and the frequency of examination in the male was higher than that in the female before age 55. The annual effective dose for two patients exceeded 100 mSv. Conclusion In this study, CT examination accounted for up to 50.88% of all medical X-ray diagnostic examinations, and contributed 97.75% of the collective effective dose, highlighting the need for particular attention to the justification of medical radiation exposure from CT.

Protein therapeutics, owing to their high specificity and potent activity, have demonstrated significant efficacy in the treatment of various ocular diseases, particularly playing a central role in posterior segment disorders such as macular degeneration, diabetic retinopathy, and uveitis.However, effective ocular delivery remains challenging because of anatomical barriers and rapid clearance mechanisms.Topical eye drops are convenient but suffer from low bioavailability and poor stability, while intravitreal injections are effective but invasive and require frequent administration.This expert commentary outlines current applications of protein drugs in the eye, evaluates key delivery challenges, and discusses the physiological barriers encountered in ocular protein delivery via eye drops, along with strategies to enhance drug stability and penetration on the ocular surface, as well as the metabolic clearance pathways following intraocular injection and approaches to prolong intraocular drug residence time.By highlighting both limitations and potential solutions, this article aims to enlighten the development of more effective ocular protein therapies.

Objective:To prepare aldolylated hyaluronic acid-modified antimicrobial carbon dots (AHA-CDs) eye drops and evaluate its antibacterial activity against Staphylococcus aureus in vitro and in vivo. Methods:AHA-CDs eye drops were synthesized by modifying small particle size positively charged carbon dots and introducing aldehyde-based hyaluronic acid.The AHA-CDs were characterized by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy.The antibacterial activity of AHA-CDs against Staphylococcus aureus was evaluated using the microdilution method, plate counting, and live-dead bacteria fluorescence staining in vitro.The mouse bacterial keratitis model was established by removing the corneal epithelium after ring drilling and inoculating Staphylococcus aureus.Eighteen conventional female C57BL/6 mice aged 6-8 weeks were selected and divided into a blank control group, an AHA-CDs-treated group and a tobramycin-treated group of 6 mice each using random number table method, and the mice were treated with phosphate buffer saline, 80 μg/ml AHA-CDs, and 80 μg/ml tobramycin eye drops three times daily for 5 consecutive days accordingly to assess antibacterial activity against Staphylococcus aureus in vivo.Another 12 mice were divided into an AHA-CDs group and a normal control group using the random number table method, with 6 mice in each group, which were treated with 80 μg/ml AHA-CDs and phosphate buffer saline for 7 days.The mice were then sacrificed.Their eyeballs were removed and stained with hematoxylin-eosin to observe and compare the morphology and integrity of the eyeballs between the two groups to evaluate the treatment's biosafety.The use and care of the animals complied with the principles of the ARRIVE guidelines.The study protocol was approved by the Ethics Committee of the Experimental Animal Care of Henan Eye Hospital (No.HNEECA-2022-17). Results:The successful preparation of AHA-CDs was demonstrated by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. In vitro studies showed that the minimum inhibitory concentration of AHA-CDs against Staphylococcus aureus was approximately 8 μg/ml, which effectively inhibited bacterial growth at a lower concentration.Plate counting results showed that only 20% of the bacteria survived after 10 minutes of treatment with AHA-CDs.Fluorescence staining of live/dead bacteria showed obvious red fluorescence signals after 4 hours of treatment with AHA-CDs and SP-CDs. In vivo studies showed that, after 5 days of treatment with AHA-CDs eye drops, the corneas of mice with bacterial keratitis were obviously transparent, and the corneal epithelium was basically repaired.In contrast, the tobramycin-treated group exhibited incomplete epithelial repair and mild corneal edema. In vivo safety evaluation revealed that the eye tissue morphology remained intact and no structural abnormalities were observed after AHA-CDs treatment. Conclusions:AHA-CDs eye drops have superior antibacterial effects in vivo and in vitro, and inactivate bacteria rapidly and effectively.

Neuropeptides, as a class of small molecule active substances with neuroregulatory and immunomodulatory functions, play a key role in the physiological and pathological processes of the cornea.Neuropeptides are synthesized, stored, and secreted by the trigeminal neurons that innervate the cornea, and communicate with immune cells, epithelial cells, and stromal cells through G protein-coupled receptors, forming a complex signaling network that maintains ocular surface homeostasis.Under normal circumstances, the release of neuropeptides promotes corneal repair and prevents pathogen invasion.However, abnormal neuropeptide synthesis or receptor dysfunction can lead to an imbalance in ocular surface homeostasis, triggering various eye diseases.This article systematically reviews the research progress of neuropeptides in corneal diseases, focusing on the mechanism of action and therapeutic potential of key neuropeptides such as calcitonin gene-related peptide, substance P, and neuropeptide Y in corneal injury repair, inflammation regulation, nerve regeneration, and pain management.At the same time, this articles discusses the development of new drug delivery strategies, the research progress of neuropeptide modulators, as well as the current challenges and future development directions to provide theoretical basis and new ideas for the clinical treatment of corneal diseases.

Objective To investigate the impact of the artificial intelligence iterative reconstruction (AIIR) algorithm on image quality in chest computed tomography (CT) at different radiation doses, and assess its value in reducing radiation dose during chest CT examinations. Methods A simulated chest phantom was scanned with 12 groups of tube voltages and milliampere-seconds, and the radiation dose was recorded for each group. The images of each group were reconstructed using seven methods: AIIR with noise levels 1-5, KARL iterative reconstruction, and filtered back projection (FBP). The CT values and standard deviations of soft tissue, thoracic vertebrae, pulmonary nodules, and the mediastinum were measured, with standard deviation representing image noise. Subjective evaluation of image quality was performed. The Friedman test was used to compare CT values among the seven reconstruction groups, a linear mixed model was employed for statistical analysis of image noise, and the Friedman test was also used for comparing subjective evaluation scores. Results The reconstruction algorithm, tube voltage, milliampere-seconds, and their interactions all showed statistically significant effects on image noise for the four tissues (F = 2.041-391.283, P < 0.05). Among the reconstruction algorithms, noise reduction capability decreased in the following order: AIIR levels 1-5, KARL, and FBP. The interaction between the reconstruction algorithm and tube voltage or milliampere-seconds indicated that AIIR exhibited improved noise reduction efficacy under low tube voltage and low milliampere-second conditions (|t| = 1.892-8.245, P < 0.05). In terms of subjective evaluation of image quality, there was no statistically significant difference among AIIR levels 3-5 (|Z| ≤ 0.567, P > 0.05), and the score of AIIR level 3 was significantly higher than those of AIIR level 1, AIIR level 2, FBP, and KARL level 2 (|Z| = 3.449-5.906, P < 0.05). Conclusion The AIIR reconstruction algorithm significantly reduced image noise in chest CT examinations. For improving image quality while maintaining image realism, AIIR level 3 is recommended, which can reduce the radiation dose by more than 75%. Furthermore, AIIR showed superior performance in noise reduction under low tube voltage and low milliampere-second conditions, demonstrating significant potential for reducing radiation dose.

Protein therapeutics, owing to their high specificity and potent activity, have demonstrated significant efficacy in the treatment of various ocular diseases, particularly playing a central role in posterior segment disorders such as macular degeneration, diabetic retinopathy, and uveitis.However, effective ocular delivery remains challenging because of anatomical barriers and rapid clearance mechanisms.Topical eye drops are convenient but suffer from low bioavailability and poor stability, while intravitreal injections are effective but invasive and require frequent administration.This expert commentary outlines current applications of protein drugs in the eye, evaluates key delivery challenges, and discusses the physiological barriers encountered in ocular protein delivery via eye drops, along with strategies to enhance drug stability and penetration on the ocular surface, as well as the metabolic clearance pathways following intraocular injection and approaches to prolong intraocular drug residence time.By highlighting both limitations and potential solutions, this article aims to enlighten the development of more effective ocular protein therapies.

Objective:To prepare aldolylated hyaluronic acid-modified antimicrobial carbon dots (AHA-CDs) eye drops and evaluate its antibacterial activity against Staphylococcus aureus in vitro and in vivo. Methods:AHA-CDs eye drops were synthesized by modifying small particle size positively charged carbon dots and introducing aldehyde-based hyaluronic acid.The AHA-CDs were characterized by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy.The antibacterial activity of AHA-CDs against Staphylococcus aureus was evaluated using the microdilution method, plate counting, and live-dead bacteria fluorescence staining in vitro.The mouse bacterial keratitis model was established by removing the corneal epithelium after ring drilling and inoculating Staphylococcus aureus.Eighteen conventional female C57BL/6 mice aged 6-8 weeks were selected and divided into a blank control group, an AHA-CDs-treated group and a tobramycin-treated group of 6 mice each using random number table method, and the mice were treated with phosphate buffer saline, 80 μg/ml AHA-CDs, and 80 μg/ml tobramycin eye drops three times daily for 5 consecutive days accordingly to assess antibacterial activity against Staphylococcus aureus in vivo.Another 12 mice were divided into an AHA-CDs group and a normal control group using the random number table method, with 6 mice in each group, which were treated with 80 μg/ml AHA-CDs and phosphate buffer saline for 7 days.The mice were then sacrificed.Their eyeballs were removed and stained with hematoxylin-eosin to observe and compare the morphology and integrity of the eyeballs between the two groups to evaluate the treatment's biosafety.The use and care of the animals complied with the principles of the ARRIVE guidelines.The study protocol was approved by the Ethics Committee of the Experimental Animal Care of Henan Eye Hospital (No.HNEECA-2022-17). Results:The successful preparation of AHA-CDs was demonstrated by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. In vitro studies showed that the minimum inhibitory concentration of AHA-CDs against Staphylococcus aureus was approximately 8 μg/ml, which effectively inhibited bacterial growth at a lower concentration.Plate counting results showed that only 20% of the bacteria survived after 10 minutes of treatment with AHA-CDs.Fluorescence staining of live/dead bacteria showed obvious red fluorescence signals after 4 hours of treatment with AHA-CDs and SP-CDs. In vivo studies showed that, after 5 days of treatment with AHA-CDs eye drops, the corneas of mice with bacterial keratitis were obviously transparent, and the corneal epithelium was basically repaired.In contrast, the tobramycin-treated group exhibited incomplete epithelial repair and mild corneal edema. In vivo safety evaluation revealed that the eye tissue morphology remained intact and no structural abnormalities were observed after AHA-CDs treatment. Conclusions:AHA-CDs eye drops have superior antibacterial effects in vivo and in vitro, and inactivate bacteria rapidly and effectively.

Neuropeptides, as a class of small molecule active substances with neuroregulatory and immunomodulatory functions, play a key role in the physiological and pathological processes of the cornea.Neuropeptides are synthesized, stored, and secreted by the trigeminal neurons that innervate the cornea, and communicate with immune cells, epithelial cells, and stromal cells through G protein-coupled receptors, forming a complex signaling network that maintains ocular surface homeostasis.Under normal circumstances, the release of neuropeptides promotes corneal repair and prevents pathogen invasion.However, abnormal neuropeptide synthesis or receptor dysfunction can lead to an imbalance in ocular surface homeostasis, triggering various eye diseases.This article systematically reviews the research progress of neuropeptides in corneal diseases, focusing on the mechanism of action and therapeutic potential of key neuropeptides such as calcitonin gene-related peptide, substance P, and neuropeptide Y in corneal injury repair, inflammation regulation, nerve regeneration, and pain management.At the same time, this articles discusses the development of new drug delivery strategies, the research progress of neuropeptide modulators, as well as the current challenges and future development directions to provide theoretical basis and new ideas for the clinical treatment of corneal diseases.

Objective To investigate the impact of sintilimab combined with TP chemotherapy regimen on immune function and prognostic survival in patients with advanced esophageal cancer.Methods A total of 82 patients with advanced esophageal cancer who received treatment in the hospital from January 2022 to October 2023 were enrolled.They were divided into two groups with 41 cases in each group using the random number table method.The control group was given the TP chemotherapy regimen,while the observation group was treated with sintilimab in addition to the TP chemotherapy regimen used in the control group.The treatment cycle was 21 days,and both groups received 4 cycles of treatment.After that,the observation group received sintilimab monotherapy for maintenance treatment for at least 1 year.The disease control rate(DCR)and objective response rate(ORR)of the patients were recorded.The immune function,levels of inflammatory factors and tumor markers before and after treatment were compared between the two groups.The swallowing function and quality of life of the patients before and after treatment were evaluated using the Swallowing Safety Assessment(SSA)and the Quality of Life Instruments for Cancer Patients-Esophageal Cancer(QLICP-ES).The occurrence of adverse reactions was also recorded.After the start of treatment,the patients were followed up for 18 months,and the overall survival(OS)and survival rate were recorded.Results In the observation group,the partial remission rate and disease control rate were 53.66%and 87.80%respectively,both higher than those in the control group.After treatment,the levels of CD3+and CD4+in the observation group were(50.48±5.61)%and(37.96±4.69)%respectively,which were higher than(44.73±5.12)%and(33.15±4.21)%in the control group.The immune function of the observation group was improved compared with the control group,while the levels of inflammatory factors and tumor markers were lower than those in the control group.The swallowing function and quality of life were significantly improved compared with the control group(P<0.05).The 18-month follow-up results showed that the median overall survival(OS)in the observation group was 16(9,17)months,and that in the control group was 9(7,14)months.The OS in the observation group was longer than that in the control group(χ2=13.394,P<0.001).The 18months survival rates in the observation group and the control group were 60.98%(25/41)and 36.59%(15/41)respec-tively,with the observation group being higher than the control group(χ2=4.881,P=0.027).Conclusion The sintilimab combined with TP chemotherapy regimen is beneficial for improving immune function and enhancing the survival status of patients with advanced esophageal cancer.

Objective To investigate the impact of sintilimab combined with TP chemotherapy regimen on immune function and prognostic survival in patients with advanced esophageal cancer.Methods A total of 82 patients with advanced esophageal cancer who received treatment in the hospital from January 2022 to October 2023 were enrolled.They were divided into two groups with 41 cases in each group using the random number table method.The control group was given the TP chemotherapy regimen,while the observation group was treated with sintilimab in addition to the TP chemotherapy regimen used in the control group.The treatment cycle was 21 days,and both groups received 4 cycles of treatment.After that,the observation group received sintilimab monotherapy for maintenance treatment for at least 1 year.The disease control rate(DCR)and objective response rate(ORR)of the patients were recorded.The immune function,levels of inflammatory factors and tumor markers before and after treatment were compared between the two groups.The swallowing function and quality of life of the patients before and after treatment were evaluated using the Swallowing Safety Assessment(SSA)and the Quality of Life Instruments for Cancer Patients-Esophageal Cancer(QLICP-ES).The occurrence of adverse reactions was also recorded.After the start of treatment,the patients were followed up for 18 months,and the overall survival(OS)and survival rate were recorded.Results In the observation group,the partial remission rate and disease control rate were 53.66%and 87.80%respectively,both higher than those in the control group.After treatment,the levels of CD3+and CD4+in the observation group were(50.48±5.61)%and(37.96±4.69)%respectively,which were higher than(44.73±5.12)%and(33.15±4.21)%in the control group.The immune function of the observation group was improved compared with the control group,while the levels of inflammatory factors and tumor markers were lower than those in the control group.The swallowing function and quality of life were significantly improved compared with the control group(P<0.05).The 18-month follow-up results showed that the median overall survival(OS)in the observation group was 16(9,17)months,and that in the control group was 9(7,14)months.The OS in the observation group was longer than that in the control group(χ2=13.394,P<0.001).The 18months survival rates in the observation group and the control group were 60.98%(25/41)and 36.59%(15/41)respec-tively,with the observation group being higher than the control group(χ2=4.881,P=0.027).Conclusion The sintilimab combined with TP chemotherapy regimen is beneficial for improving immune function and enhancing the survival status of patients with advanced esophageal cancer.