AIM:To investigate the clinical efficacy of phakic implantable collamer lens(ICL)implantation in correcting low-to-moderate myopia.METHODS: Retrospective study. A total of 48 patients(85 eyes)with low to moderate myopia who underwent ICL implantation were included in the study. The changes in uncorrected visual acuity(LogMAR), corrected visual acuity(LogMAR), refractive outcomes, intraocular pressure, vault and endothelial cell were observed at 1 a postoperatively.RESULTS: At 12 mo postoperatively, uncorrected and best-corrected visual acuity were -0.10(-0.20, -0.10)and -0.10(-0.20, -0.10), respectively, with an efficacy index of 1.07±0.13 and a safe index of 1.10±0.14. The difference between the actual corrected diopter and the expected corrected diopter was 91%(77/85)in the range of ±0.50 D, and 100%(85/85)in the range of ±1.00 D. The mean vault was 501.16±210.46 μm at 12 mo postoperatively. There was no significant difference in corneal endothelial cell density between preoperative and 6 and 12 mo postoperatively(F=1.050, P=0.352). All patients had no anterior subcapsular opacification, cataract, pupillary block, or other sight threatening complications during follow-up.CONCLUSION: ICL implantation for the correction of low to moderate myopia has good efficacy, safety and predictability.

Objective To evaluate clinical value of MGFA classification and QMG score on pre-dicting late extubation after thymectomy for myasthenia gravis(MG).Methods Total of 61 patients with MG received extended thymectomy from January 2007 to February 2012 were enrolled.Patients were divided into two groups:normal extubation group contained the other 47 patients without pro-longed postoperative mechanical ventilation and delayed extubation group included 14 patients with prolonged postoperative mechanical ventilation.The following factors were evaluated:gender,age, weight,MGFA classification,QMG score,history of steroid hormones or anticholinesterase drugs be-fore operation,the function of liver and kidney before operation,preoperative electrolyte,preoperative hemoglobin content,etc.Receiver operator characteristic curve (ROC)was plotted,and the predictive value, sensitivity and specificity of preoperative MGFA clinical classification and QMG score predicting postoperative ventilation in MG were calculated.Results Fourteen patients(22.95%)de-veloped breathing support after the anaesthetic or endotracheal intubation again in 48 hours.the area under ROC curve(AUC)for preoperative MGFA clinical classification predicting postoperative ventila-tion was 0.723 in MG,it had the sensitivity of 78.5% and specificity of 63.8%.The AUC for QMG score predicting postoperative ventilation was 0.866,the QMG score threshold value of 8.5 had the sensitivity of 78.6% and specificity of 87.2%.Conclusion MGFA classification and QMG score can predict late extubation after thymectomy in patients with myasthenia gravis.

Objective: To evaluate the effects of ferroptosis in hippocampal neurons on cognitive dysfunction in rats with sepsis-associated encephalopathy (SAE) and its potential molecular mechanisms. Methods: ① Screening experiment of SAE modeling conditions: 42 healthy male Sprague-Dawley (SD) rats were divided into normal saline (NS) control group (n = 6) and lipopolysaccharide (LPS) 5, 15, 30 mg/kg groups (each n = 12) according to the random number table method. The SAE modeling conditions were determined by survival and the changes in mean arterial pressure (MAP) and heart rate (HR) within 72 hours, the percentage of stiffness status, the levels of serum inflammatory factors including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), neuron specific enolase (NSE, a marker of neuronal injury), serum iron and lactic acid (Lac) contents, and the morphological changes in CA1 of hippocampus after 72 hours. ② Deferoxamine (Def) intervention experiment: according to the results of screening experiments, 28 healthy male SD rats were divided into NS control group (n = 8), SAE group (n = 10) and Def+SAE group (n = 10) according to the random number table method. In the Def+SAE group, 100 mg/kg Def was injected intraperitoneally 12 hours before the modeling, once every 12 hours, with a total of 7 times; the rats in the NS control group and SAE group were injected with the same amount of NS. Then the cognitive function of rats was evaluated by fear conditioning test for the percentage of stiffness status; serum IL-6, TNF-α and NSE levels were determined by enzyme-linked immunosorbent assay (ELISA); the levels of serum Lac, serum iron and hippocampal malondialdehyde (MDA) and iron contents were determined by chemical colorimetric; the protein expressions of nuclear factor E2 related factor 2 (Nrf 2), glutathione peroxidase 4 (GPX4) and NAPDH oxidase 1 (NOX1) in hippocampus were determined by Western Blot; morphological changes in hippocampal CA1 were observed after hematoxylin and eosin (HE) staining. Results: ① Compared with the NS control group, intraperitoneal injection of 15 mg/kg LPS could significantly reduce the MAP and HR as time prolonged, and the reduction was most significant at 72 hours. The 72-hour survival rate was significantly reduced and cognitive function was impaired. The levels of serum IL-6, TNF-α, Lac and NSE were increased while the serum iron content was decreased significantly. The morphology of vertebral cells in hippocampal CA1 was irregular and some of the cells were obviously vacuolated. In the LPS 5 mg/kg group, there were no significant changes in vital signs, inflammation, organ function or cognitive dysfunction, while the symptoms of septic shock were apparent in the LPS 30 mg/kg group. Therefore, SAE model was reproduced by intraperitoneal injection of 15 mg/kg LPS for 72 hours. ② Compared with the NS control group, the percentage of stiffness in the SAE group was significantly reduced. The levels of serum IL-6, NSE and hippocampal MDA, iron were significantly increased. The serum iron contents and hippocampal Nrf 2 and GPX4 protein expressions were significantly reduced, while the hippocampal NOX1 protein expression was significantly increased. The morphology of vertebral cells in hippocampal CA1 was irregular and the cytoplasm was deeply stained. The results indicated that the level of oxidative stress in the hippocampus of SAE rats was increased, the neuron degenerations were obvious, and the cognitive function of rats were impaired. Compared with the SAE group, the percentage of stiffness in the Def+SAE group was significantly increased [(63.4±6.4)% vs. (47.6±6.0)%, P < 0.05]. The levels of serum IL-6, NSE, iron and hippocampal MDA, iron were significantly reduced [serum IL-6 (ng/L): 73.14±8.31 vs. 99.86±12.37, serum NSE (μg/L): 3.67±0.51 vs. 5.92±0.79, serum iron (mg/L): 68.43±8.12 vs. 134.60±15.63, hippocampal MDA (mol/g): 4.62±0.90 vs. 6.62±0.84, hippocampal iron (μg/g): 155.32±17.86 vs. 221.54±27.54, all P < 0.05]. The hippocampal protein expressions of Nrf 2 and GPX4 were significantly increased [Nrf 2/β-actin: 0.41±0.07 vs. 0.18±0.03, GPX4/β-actin: 0.74±0.09 vs. 0.40±0.06, all P < 0.05] while the hippocampal NOX1 protein expression was significantly reduced (NOX1/β-actin: 0.62±0.08 vs. 1.11±0.16, P < 0.05). The vertebral cells was significantly improved as compared with the SAE group. These findings showed that the oxidative stress level in hippocampus of the Def+SAE group was reduced, neuron degeneration was significantly alleviated, and the cognitive function of the rats was significantly improved. Conclusions The cognitive function of rats with SAE was significantly impaired, the hippocampal neurons were obviously damaged and ferroptosis was increased. Def pretreatment could significantly reduce iron deposition and ferroptosis in hippocampal neurons of SAE rats and improve cognitive dysfunction, which may be related to activation of Nrf 2/GPX4 signaling pathway.

OBJECTIVE: To evaluate the effects of ferroptosis in hippocampal neurons on cognitive dysfunction in rats with sepsis-associated encephalopathy (SAE) and its potential molecular mechanisms. METHODS: (1) Screening experiment of SAE modeling conditions: 42 healthy male Sprague-Dawley (SD) rats were divided into normal saline (NS) control group (n = 6) and lipopolysaccharide (LPS) 5, 15, 30 mg/kg groups (each n = 12) according to the random number table method. The SAE modeling conditions were determined by survival and the changes in mean arterial pressure (MAP) and heart rate (HR) within 72 hours, the percentage of stiffness status, the levels of serum inflammatory factors including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), neuron specific enolase (NSE, a marker of neuronal injury), serum iron and lactic acid (Lac) contents, and the morphological changes in CA1 of hippocampus after 72 hours. (2) Deferoxamine (Def) intervention experiment: according to the results of screening experiments, 28 healthy male SD rats were divided into NS control group (n = 8), SAE group (n = 10) and Def+SAE group (n = 10) according to the random number table method. In the Def+SAE group, 100 mg/kg Def was injected intraperitoneally 12 hours before the modeling, once every 12 hours, with a total of 7 times; the rats in the NS control group and SAE group were injected with the same amount of NS. Then the cognitive function of rats was evaluated by fear conditioning test for the percentage of stiffness status; serum IL-6, TNF-α and NSE levels were determined by enzyme-linked immunosorbent assay (ELISA); the levels of serum Lac, serum iron and hippocampal malondialdehyde (MDA) and iron contents were determined by chemical colorimetric; the protein expressions of nuclear factor E2 related factor 2 (Nrf2), glutathione peroxidase 4 (GPX4) and NAPDH oxidase 1 (NOX1) in hippocampus were determined by Western Blot; morphological changes in hippocampal CA1 were observed after hematoxylin and eosin (HE) staining. RESULTS: (1) Compared with the NS control group, intraperitoneal injection of 15 mg/kg LPS could significantly reduce the MAP and HR as time prolonged, and the reduction was most significant at 72 hours. The 72-hour survival rate was significantly reduced and cognitive function was impaired. The levels of serum IL-6, TNF-α, Lac and NSE were increased while the serum iron content was decreased significantly. The morphology of vertebral cells in hippocampal CA1 was irregular and some of the cells were obviously vacuolated. In the LPS 5 mg/kg group, there were no significant changes in vital signs, inflammation, organ function or cognitive dysfunction, while the symptoms of septic shock were apparent in the LPS 30 mg/kg group. Therefore, SAE model was reproduced by intraperitoneal injection of 15 mg/kg LPS for 72 hours. (2) Compared with the NS control group, the percentage of stiffness in the SAE group was significantly reduced. The levels of serum IL-6, NSE and hippocampal MDA, iron were significantly increased. The serum iron contents and hippocampal Nrf2 and GPX4 protein expressions were significantly reduced, while the hippocampal NOX1 protein expression was significantly increased. The morphology of vertebral cells in hippocampal CA1 was irregular and the cytoplasm was deeply stained. The results indicated that the level of oxidative stress in the hippocampus of SAE rats was increased, the neuron degenerations were obvious, and the cognitive function of rats were impaired. Compared with the SAE group, the percentage of stiffness in the Def+SAE group was significantly increased [(63.4±6.4)% vs. (47.6±6.0)%, P < 0.05]. The levels of serum IL-6, NSE, iron and hippocampal MDA, iron were significantly reduced [serum IL-6 (ng/L): 73.14±8.31 vs. 99.86±12.37, serum NSE (μg/L): 3.67±0.51 vs. 5.92±0.79, serum iron (mg/L): 68.43±8.12 vs. 134.60±15.63, hippocampal MDA (mol/g): 4.62±0.90 vs. 6.62±0.84, hippocampal iron (μg/g): 155.32±17.86 vs. 221.54±27.54, all P < 0.05]. The hippocampal protein expressions of Nrf2 and GPX4 were significantly increased [Nrf2/β-actin: 0.41±0.07 vs. 0.18±0.03, GPX4/β-actin: 0.74±0.09 vs. 0.40±0.06, all P < 0.05] while the hippocampal NOX1 protein expression was significantly reduced (NOX1/β-actin: 0.62±0.08 vs. 1.11±0.16, P < 0.05). The vertebral cells was significantly improved as compared with the SAE group. These findings showed that the oxidative stress level in hippocampus of the Def+SAE group was reduced, neuron degeneration was significantly alleviated, and the cognitive function of the rats was significantly improved. CONCLUSIONS The cognitive function of rats with SAE was significantly impaired, the hippocampal neurons were obviously damaged and ferroptosis was increased. Def pretreatment could significantly reduce iron deposition and ferroptosis in hippocampal neurons of SAE rats and improve cognitive dysfunction, which may be related to activation of Nrf2/GPX4 signaling pathway.
Animals ; Cognitive Dysfunction ; Ferroptosis ; Hippocampus ; Male ; NF-E2-Related Factor 2/metabolism* ; Neurons ; Rats ; Rats, Sprague-Dawley ; Sepsis ; Sepsis-Associated Encephalopathy ; Signal Transduction ; Tumor Necrosis Factor-alpha

OBJECTIVE: To investigate the expression and clinical significance of oncogene AKT2 in laryngeal squamous cell carcinoma (LSCC). METHOD: The expression of AKT2 protein was measured with immunohistochemistry (Elivision two steps) in 60 cases of LSCC tissue, 28 cases of peri-cancer tissue and 16 cases of normal laryngeal epithelium, the relationship between AKT2 expression and clinical pathologic factors in LSCC was also analyzed. RESULT: The positive rates of AKT2 protein expression in LSCC and peri-cancer tissue were 56.7% (34/60), 14.3% (4/28) respectively. There was no expression of AKT2 in normal laryngeal epithelium. The positive rate of AKT2 protein expression in LSCC was significantly higher than that in peri-cancer tissue and normal laryngeal epithelium (P < 0.05, respectively). The positive rate of AKT2 was correlated with tumor site, lymph node metastasis and clinical stage of LSCC (P < 0.05, respectively), but wasn't correlated with patient's age, sex, and T stage (P > 0.05, respectively). CONCLUSION AKT2 might play an important role in the tumorigenesis and development of LSCC, and it was suggested that AKT2 could be a useful marker for predicting tumorigenesis, invasion and metastasis potential of LSCC.
Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Female ; Humans ; Laryngeal Mucosa ; metabolism ; pathology ; Laryngeal Neoplasms ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proto-Oncogene Proteins c-akt ; metabolism

Objective: To compare the effects of general anesthesia, intraspinal anesthesia combined with general anesthesia and lumbar plexus block combined with general anesthesia on the volume load of lower limb joint replacement surgery in patients with coronary heart disease. Methods: One hundred and twenty patients (ASA classification Ⅱ-Ⅲ) with coronary heart disease who underwent selective lower extremity arthroplasty in Hubei Aerospace Hospital from January 2017 to November 2018 were randomly divided into three groups: general anesthesia group (group A), spinal canal combined with superficial general anesthesia group (group B) and lumbar plexus nerve block combined with superficial general anesthesia group (group C), with 40 cases in each group. The mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI) and stroke volume variation (SVV) were observed and recorded at the time of entering operation room (T₀), immediate induction of anesthesia(T₁), immediately after the operation (T₂), 1 h after surgery (T₃) and at the end of the operation (T₄) in three groups. The operation time, anesthesia time and the incidence of complications of the three groups were recorded. Results: At T₁, HR, MAP, CI and SVV of the three groups were lower than T₀, and SVV were higher than T₀, and there were significant differences (P < 0.05). At T₁ and T₂, the MAP, CI and SVI in group B were significantly lower than those in group A and group C[T₁: (76.8 ± 5.4) mmHg (1 mmHg=0.133 kPa)vs. (84.4 ± 14.9) and (86.4 ± 19.1) mmHg, (1.9 ± 0.6) L/(min·m²) vs. (2.5 ± 0.7) and (2.3 ± 0.5) L/(min·m²), (35.5 ± 11.5) ml/m² vs.(40.5 ± 11.8) and (39.2 ± 10.3) ml/m²; T₂: (74.6 ± 6.7) mmHg vs. (89.9 ± 17.8) and (82.8 ± 19.7) mmHg, (2.6 ± 0.7) L/(min·m²) vs. (2.8 ± 0.7) and (2.6 ± 0.4) L/(min·m²), (38.2 ± 13.7) ml/m² vs. (44.9 ± 7.9) and (45.8 ± 8.3) ml/m²], and at T₁, the SVV of group B was significantly higher [(15.6 ± 2.1)% vs. (13.8 ± 4.3)% and (13.9 ± 2.9)%], and there were significant differences (P < 0.05). At T₂-T₄, the HR and MAP of group A were significantly higher than those of the other two groups (P < 0.05). The incidence of hypertension, hypotension and unstable angina pectoris in group C was significantly lower than that in group A and group B [5.0%(2/40) vs. 20.0%(8/40) and 35.0%(14/80)](P < 0.05). Conclusions Lumbar plexus block combined with shallow general anesthesia is safer for patients with coronary heart disease because of its smaller fluctuation of volume load index, more stable hemodynamics and lower incidence of cardiovascular adverse events.

OBJECTIVETo investigate the acquaintance to orthodontics and possible factors that obstruct orthodontic treatment in middle school students in zones with different economic levels in Jiangjin, Chongqing.

METHODSThe students were randomly divided into four groups: A class from a junior high school in town (group 1), a class from a senior high school in town (group 2), a class from a junior high school in the countryside (group 3), a class from a senior high school in the countryside (group 4). The information was collected by questionnaire, and the statistical analysis of results was carried out by SPSS 17.0 software.

RESULTSSex made difference in the acquaintance to orthodontics treatment. Girls worried more about teeth extraction and pain that may occur during treatment than the boys. Students in the city had more access to related consultations compared to those in the countryside. Different economic conditions made much contribution to the proportion to go for orthodontics treatment in cities and rural areas. The evaluation from families and friends may affect patients' subjective estimation to themselves.

CONCLUSIONOrthodontists should learn more about student patiens from various aspects, and make different therapies according to their sexes, economic conditions of family, education levels, etc. Only so can orthodontists get better compliance from their patients.

Objective To explore the effect of enhancing nursing quality by combining partitioned management mode and hierarchical use of nurses in the pediatric emergency room .Methods The pediatric emergency room was partitioned into rescue area , observation area , transfusion area and patient ’ s condition evaluation area .The nursing staff was analyzed and evaluated by capability , professional title , work years and classified into senior charge nurse , intermediate charge nurse and junior charge nurse .The rescue success rate and the nursing adverse event rate were compared before ( from July to December , 2009 ) and after ( from July to December , 2011 ) applying the partitioned management mode and hierarchical use of nurses .Results The nursing adverse event rate was 0.025 2%(15/59 452) in the control group and 0.005 8%(4/68 790) in the intervention group, and the difference was significant (χ2 =8.12, P<0.05).The rescue success rate was 97.57% (201/206) in the control group and 99.61%(256/257) in the intervention group, and the difference was significant (χ2 =7.32, P<0.05).Conclusions The combined application of partitioned management mode and hierarchical use of nurses in pediatric emergency room has obvious effects in enhancing the quality of pediatric emergency nursing .

ObjectiveTo explore the influence of systemic stress management policy on the stigma, treatment compliance, and life quality of patients with chronic hepatitis B(CHB). MethodsBy convenience sampling, 110 CHB patients in the Department of Infectious Disease of Yancheng Third People's Hospital from May 2017 to May 2018 were selected and divided into the observation group(n=55) and control group(n=55) according to the random number table. The control group was given conventional nursing intervention, on the basis of that, the observation group was given intervention based on the systemic stress management policy. The two groups were compared in terms of the stigma, treatment compliance before and 2 weeks after intervention, and follow-up visit after 6 month's intervention was conducted to measure and evaluate the patients' quality of life. ResultsA total of 103 valid questionnaires were collected, 52 in observation group and 51 in control group. Before intervention, there was no statistical difference in total scores of "social rejection" , "economic rejection", "inner shame", "social isolation" and stigma as well as treatment compliance between the two groups (P＞ 0.05) ; after intervention, the total score of stigma in the observation group (32.95±5.25) was lower than the control group (76.15±8.68) with statistical difference (P＜ 0.01), moreover the observation group scored lower than the control group in the "social rejection", "inner shame" and "social isolation" with statistical differences (P＜0.01). After intervention for 2 weeks, the treatment compliance of observation group was higher than control group with statistical difference (P＜0.05). Before intervention, there was no statistical difference between the two groups in the scores of life quality and each dimensions(P＞0.05); 6 months after intervention, the observation group were higher than the control group in the scores of quality of life and each dimensions with statistical significances(P＜ 0.01). ConclusionsSystemic stress management policy can effectively improve the CHB patients' stigma and improve their treatment compliance as well as their quality of life, and is worthy of clinical promotion.

OBJECTIVE: To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome (ARDS). METHODS: A prospective control study was conducted. A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects. According to the envelope method, the patients were divided into the lateral prone position ventilation group (38 cases) and the traditional prone position ventilation (PPV) group (37 cases), using lateral prone position ventilation and traditional PPV, respectively. The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups, and the time of prone position for the first 3 times was not less than 16 hours per day. General data of patients were recorded, including heart rate (HR), mean arterial pressure (MAP), airway resistance and lung static compliance (Cst) before prone position (T0), 1 hour (T1), 4 hours (T2), 8 hours (T3), and before the end of prone position (T4), oxygenation index (PaO₂/FiO₂) before the first prone position (t0) and 12 hours (t1), 24 hours (t2), 48 hours (t3), and 72 hours (t4) after the intensive care unit (ICU) admission, as well as the incidence of pressure injury (PI) and vomiting, tracheal intubation time, and mechanical ventilation time. Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position. RESULTS: There were no significant differences in age, gender, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II), underlying diseases, HR, MAP, pH value, PaO₂/FiO₂, blood lactic acid (Lac), arterial blood pressure of carbon dioxide (PaCO₂) and other general information between the two groups. The HR (intergroup effect: F = 0.845, P = 0.361; time effect: F = 1.373, P = 0.247; interaction: F = 0.245, P = 0.894), MAP (intergroup effect: F = 1.519, P = 0.222; time effect: F = 0.169, P = 0.954; interaction: F = 0.449, P = 0.773) and airway resistance (intergroup effect: F = 0.252, P = 0.617; time effect: F = 0.578, P = 0.679; interaction: F = 1.467, P = 0.212) of T0-T4 between two groups showed no significant difference. The Cst of T0-T4 between the two groups showed no significant difference in the intergroup effect (F = 0.311, P = 0.579) and the interaction (F = 0.364, P = 0.834), while the difference in the time effect was statistically significant (F = 120.546, P < 0.001). The PaO₂/FiO₂ of t0-t4 between the two groups showed no significant difference in the intergroup effect (F = 0.104, P = 0.748) and the interaction (F = 0.147, P = 0.964), while the difference in the time effect was statistically significant (F = 17.638, P < 0.001). The group factors and time factors were tested separately, and there were no significant differences in the HR, MAP, airway resistance, Cst, PaO₂/FiO₂ between the two groups at different time points (all P > 0.05). The Cst at T1-T4 and PaO₂/FiO₂ at t1-t4 in the two groups were significantly higher than those at T0/t0 (all P < 0.05). There were no significant differences in the tracheal intubation time [days: 6.75 (5.78, 8.33) vs. 7.00 (6.30, 8.45)] and mechanical ventilation time [days: 8.30 (6.70, 9.20) vs. 7.40 (6.80, 8.75)] between the lateral prone position ventilation group and the traditional PPV group (both P > 0.05). However, the incidences of PI [7.9% (3/38) vs. 27.0% (10/37)] and vomiting [10.5% (4/38) vs. 29.7% (11/37)] in the lateral prone position ventilation group were significantly lower than those in the traditional PPV group (both P < 0.05). CONCLUSIONS Both lateral prone position ventilation and traditional PPV can improve Cst and oxygenation in patients with moderate to severe ARDS. The two types of prone position have little influence on HR, MAP and airway resistance of patients, and there is no difference in the influence on tracheal intubation time and mechanical ventilation time of patients. However, the lateral prone position ventilation mode can reduce the incidence of PI and vomiting, and is worthy of clinical promotion and application.
Humans ; Respiration, Artificial ; Prone Position ; Prospective Studies ; Lung ; Respiratory Distress Syndrome/therapy* ; Respiration ; Vomiting