Objective:To investigate the efficacy and safety of the application of microwave ablation assisted clamp-less suture-less nephron sparing surgery technique in the management of cystic renal cell carcinoma.Methods:The data of 21 consecutive patients with cystic renal cell carcinoma who underwent microwave ablation assisted clamp-less suture-less laparoscopic nephron sparing surgery (MACS-LNSS) in Renji Hospital, Shanghai Jiaotong University School of Medicine from January 2017 to December 2020, were retrospectively analyzed. There were 17 males and 4 females with a mean age of (58.0±2.6) years old. There were 19 cases with Eastern Cooperative Oncology Group (ECOG) score 0 and 2 with score 1. The mean diameter of the tumor was (3.6±0.4) cm, and the mean distance from the collecting system was (10.7±0.9) mm with 12 located on the left and 9 on the right side. There were 5 cases of Bosniak Ⅲ with mean CT value (27.6±4.6) HU and 16 of Bosniak Ⅳ and the mean estimated glomerular filtration rate(eGFR) was (84.1±4.1 ) ml/(min·1.73 m 2). The American Society of Anesthesiology (ASA) graded 17 cas as grade 1, 3 cases as grade 2 and 1 cases as grade 3. MACS-LNSS was performed for all patients. The microwave ablation probe was introduced via the laparoscopic trocar and inserted into the tumor. Then all tumors were resected after microwave ablation was performed for 1 to 3 cycles lasting 2 to 5 minutes for each tumour with a power output of 60 to 100 W using an MTC-3C microwave ablation system. Results:MACS-LNSS was successfully performed in 20 cases. Another one converted to conventional laparoscopic partial nephrectomy because of intraoperative bleeding with 14 min renal artery branch clamped. No case converted to open surgery or radical nephrectomy. The mean operative time was (92.0±6.3) min, with a mean estimated blood loss of (60.0±7.2) ml. The mean length of postoperative hospital stay was (2.7±0.1) d. No case required perioperative transfusion. One case with fever and one case with urine leakage were observed postoperatively and recovered after conservative treatment. Pathologic results revealed 18 cases of clear cell carcinoma, 3 of low grade malignant potential multilocular cystic renal cell tumors. The median eGFR at 6 months postoperative was (82.9±3.8) ml/(min·1.73 m 2).No local recurrence and distant metastasis was observed with a mean follow-up of (41.3±1.5)(range from 32 to 58) months. Conclusions:MACS-LNSS which has the advantages of controllable complications is an alternative, safe and feasible technique for cystic renal cell carcinoma less than 7 cm, with regular tumor base, and the distance from the collecting system more than 5 mm.

Objective:To observe the efficacy of vitrectomy combined with subretinal injection of tissue plasminogen activator (t-PA) in the treatment of macular hemorrhage (SMH).Method:An observational case series study was performed.Twelve eyes of 12 SMH patients diagnosed in Tianjin Medical University Eye Hospital were included from February 2022 to November 2022, including 11 eyes of polypoid choroidal vascular disease (PCV) and 1 eye of retinal artery aneurysm.There were 5 males and 7 females, aged 56 to 78 years old, with an average age of (65.67±8.09) years.Two eyes had intraocular lenses and 10 eyes were with cataracts.Nine cases had hypertension and 2 cases had diabetes.The duration of SMH was 2 to 25 days, with an average of (14.67±8.03) days.Vitrectomy combined with subretinal injection of t-PA was performed in the 12 eyes.All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect ophthalmoscopy, optical coherence tomography (OCT), and ultra-wide-filed imaging examinations before and 1, 3, 6 months after surgery.The central retinal thickness (CRT) was examined using an OCT instrument.The postoperative ocular conditions and the occurrence of adverse effects were observed.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2022JS-05).Written informed consent was obtained from each patient before surgery.Results:The preoperative, 1-, 3-, and 6-month postoperative average BCVA (LogMAR) of the affected eye was 1.58±0.63, 1.12±0.49, 1.07±0.44, and 0.59±0.19, respectively, showing a statistically significant overall difference ( F=14.435, P<0.001).The BCVA at 6 months after surgery was significantly better than that before surgery ( P<0.001).The preoperative, 1-, 3-, and 6-month postoperative average CRT of the affected eye was (606.25±204.67), (379.83±92.05), (313.75±60.87), and (267.75±73.07)μm, respectively, showing a statistically significant overall difference ( F=27.720, P<0.001).The CRT at 1, 3, 6 months after surgery were significantly thinner than that before surgery (all at P<0.001).One eye had suprachoroidal hemorrhage 3 months after surgery, and 6 eyes received intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs due to recurrent PCV during follow-up, with a total of 16 injections.The average number of anti-VEGF injections at 1, 3, and 6 months after surgery was (0.3±0.5), (1.3±1.4), and (2.7±2.0) times, respectively. Conclusions:In the treatment of SMH, vitrectomy combined with subretinal injection of t-PA can improve BCVA, reduce CRT, reduce retinal damage from blood clots, and promote early postoperative visual recovery.It is a safe and effective surgical procedure.

Objective:To evaluate the accuracy, completeness, and reproducibility of domestic open-source large language models (LLM) in diabetic retinopathy (DR) patient education, and to explore their potential as intelligent virtual assistants for DR patient education.Methods:A total of 41 questions and answers related to the diagnosis and treatment of DR in five categories, namely risk factors, screening and examination, symptoms and staging, diagnosis, treatment and prognosis.All questions were repeated twice as a " new dialogue" in the LLM, and all the answers were recorded.Three senior fundus physicians independently evaluated the answers on a 6-point Likert scale for accuracy and a 3-point Likert scale for completeness and repeatability, and for each answer, the evaluator was asked to make a recommendation between the LLM and the manual answers.Five questions were randomly selected to evaluate the three open source LLM, ERNIE Bot 3.5, Qwen and Kimi chat, and the LLM with the best overall performance was selected for further evaluation in the full question bank.Results:Among the three LLM, Kimi chat had the best overall performance, Kimi chat performed best, with percentages of 6 for accuracy, 3 for completeness, and 3 for repeatability among the 5 questions at 90%, 90%, and 100%, respectively.For all questions answered, the number of words in manual replies was 106 (70, 202), which was significantly lower than 505 (386, 600) in Kimi chat ( Z=-7.866, P<0.001).There was no significant correlation between the number of Kimi chat replies and the accuracy score ( rs=-0.044, P=0.492), but it was positively correlated with the integrity score ( rs=0.239, P<0.001).The interclass correlation coefficient for accuracy and completeness scores were above 0.700 among three evaluators, with the highest agreement for repeatability at 0.853, followed by completeness of the first response at 0.771.The proportion of responses ≥5 points for accuracy was 87.0%(214/246), the proportion ≥2 points for completeness was 98.0%(241/246), and the proportion higher than 70% for repeatability was 78.5%(193/246).Kimi chat excelled in answering basic questions about the disease such as disease definition, staging, frequency of screening, and common risk factors, but performed poorly on questions involving treatment choices that require a doctor's professional judgment.The proportion of evaluators choosing Kimi chat responses as superior was 69.5% (171/246), and the reasons for non-selection included lack of characteristic answers, inclusion of too much irrelevant information, and lack of responses to questions requiring a high degree of medical expertise. Conclusions:Kimi chat answers DR-related diagnostic questions in a detailed and well-organized manner, with a high degree of accuracy, completeness and reproducibility.

Objective:To explore the role and mechanism of P311 in the differentiation of mouse skin fibroblasts (Fbs) into myofibroblasts.Methods:The study was an experimental research. Six 2-day-old male C57BL/6 mouse were used to extract skin Fbs by enzymatic hydrolysis method and routinely cultured. The 1 st to 3 rd passage cells were taken and divided into empty vector group transfected with empty adenovirus and P311 group transfected with P311 high expression adenovirus, and P311+myocardin-related transcription factor A (MRTF-A) small interfering RNA (siMRTF-A) group transfected with P311 high expression adenovirus and siMRTF-A according to the random number table. After 72 h of culture, the cell proliferation vitality of cells in 3 groups was detected by cell counting kit 8, the protein expressions of MRTF-A, α-smooth muscle actin (α-SMA), and serum response factor (SRF) in cells in 3 groups were detected by Western blotting, the collagen gel contraction assay was performed and the 72 h gel contraction rates in 3 groups were calculated. The sample numbers in the above experiments were all 3. The protein expressions of MRTF-A and SRF in cells, cytoplasm, and nucleus in cells in empty vector group and P311 group were detected by Western blotting, with sample number of 4. Results:After 72 h of culture, the cell proliferation vitality of cells in empty vector group, P311 group, and P311+siMRTF-A group was similar ( P>0.05). After 72 h of culture, compared with those in empty vector group, the protein expressions of MRTF-A, α-SMA, and SRF in cells in P311 group were significantly increased ( P<0.05), while the protein expressions of MRTF-A and SRF in cells in P311+siMRTF-A group were significantly decreased ( P<0.05). Compared with those in P311 group, the protein expressions of MRTF-A, SRF, and α-SMA in cells in P311+siMRTF-A group were significantly decreased ( P<0.05). The 72 h gel contraction rate showing cell contractility in P311 group was (84.8±6.2)%, which was significantly higher than (27.8±2.6)% in empty vector group and (24.7±3.2)% in P311+siMRTF-A group (with P values all <0.05). The 72 h gel contraction rates in empty vector group and P311+siMRTF-A group were similar ( P>0.05). After 72 hours of culture, the protein expressions of MRTF-A (with t values of 5.86 and 3.77, respectively, P<0.05) and SRF (with t values of 3.95 and 3.97, respectively, P<0.05) in cells and cytoplasm in P311 group were significantly higher than those in empty vector group, while the protein expressions of MRTF-A and SRF in the nucleus of cells were similar between the two groups ( P>0.05). Conclusions:P311 can promote the differentiation of fibroblasts into myofibroblasts through MRTF-A, and then participate in scar formation.

Background: Long coronavirus disease 2019 (COVID-19) in recovered patients (RPs) is gradually recognized by more people. However, how long it will last and the underlining mechanism remains unclear. Methods: We conducted a prospective follow-up study to evaluate the long-term symptoms and clinical indices of RPs at one-year after discharge from Union Hospital, Wuhan, China between December 2020 to May 2021. We also performed the 16S rRNA sequencing of stool samples from RPs and healthy controls (HCs) and analyzed the correlation between the gut microbiota and long COVID-19. Results: In total, 187 RPs were enrolled, among them, 84 (44.9%) RPs reported long COVID-19 symptoms at one-year after discharge. The most common long-term symptoms were cardiopulmonary symptoms, including chest tightness after activity (39/187, 20.9%), palpitations on exercise (27/187, 14.4%), sputum (21/187, 11.2%), cough (15/187, 8.0%) and chest pain (13/187, 7.0%), followed by systemic symptoms including fatigue (34/187, 18.2%) and myalgia (20/187, 10.7%), and digestive symptoms including constipation (14/187, 7.5%), anorexia (13/187, 7.0%), and diarrhea (8/187, 4.3%). Sixty-six (35.9%) RPs presented either anxiety or depression (42/187 [22.8%] and 53/187 [28.8%] respectively), and the proportion of anxiety or depression in the long symptomatic group was significantly higher than that in the asymptomatic group (41/187 [50.6%] vs. 25/187 [24.3%]). Compared with the asymptomatic group, scores of all nine 36-Item Short Form General Health Survey domains were lower in the symptomatic group (all P < 0.05). One hundred thirty RPs and 32 HCs (non-severe acute respiratory syndrome coronavirus 2 infected subjects) performed fecal sample sequencing.Compared with HCs, symptomatic RPs had obvious gut microbiota dysbiosis including significantly reduced bacterial diversities and lower relative abundance of short-chain fatty acids (SCFAs)-producing salutary symbionts such as Eubacterium_hallii_group, Subdoligranulum, Ruminococcus, Dorea, Coprococcus, and Eubacterium_ventriosum_group. Meanwhile, the relative abundance of Eubacterium_hallii_group, Subdoligranulum, and Ruminococcus showed decreasing tendencies between HCs, the asymptomatic group, and the symptomatic group. Conclusion This study demonstrated the presence of long COVID-19 which correlates with gut microbiota dysbiosis in RPs at one-year after discharge, indicating gut microbiota may play an important role in long COVID-19.

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) at admission for stroke associated pneumonia (SAP) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the First Affiliated Hospital of Kunming Medical University from January 2019 to June 2020 were retrospectively included. The demographic information, vascular risk factors, severity of stroke at admission, and NLR data of the patients were collected. Multivariate logistic regression was used to analyze the independent correlation between NLR and SAP. The NLR was divided into quartile groups to further analyze the trend relationship between NLR and SAP. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of NLR for SAP. Results:A total of 316 patients with AIS were enrolled, including 200 males (63.29%) with an age of 63.86±13.78 years. The median baseline Nationanl Institutes of Health Stroke Scale score was 4 (interquartile range, 2-9), and the median NLR was 4.42 (interquartile range, 3.17-6.70). Ninety-three patients (29.43%) experienced SAP. Multivariate logistic regression analysis showed that NLR was an independent risk factor for SAP in patients with AIS (odds ratio 1.189, 95% confidence interval 1.077-1.313; P<0.001). Moreover, SAP risk increases with the increase of NLR ( Ptrend<0.001). Compared to the first quartile, the risk of SAP increased 9.991 times in the fourth quartile (95% confidence interval 2.912-34.279; P<0.001). ROC curve analysis showed that the area under the curve of NLR for SAP prediction was 0.793 (95% confidence interval 0.737-0.850), with an optimal cutoff value of 5.475. The sensitivity and specificity for predicting SAP were 66.67% and 79.82%, respectively. Conclusion:NLR at admission is an independent risk factor for SAP in patients with AIS and has certain predictive value for SAP.

Objective:To characterize proteomic profile in aqueous humor of patients with high myopia using quantitative proteomic analysis.Methods:Sixty-eight age-related cataract patients were divided into high myopic cataract group and simple cataract group according to that they had high myopia or not, with 34 patients (34 eyes) in each group.Aqueous humor samples (100 μl/patient) were collected from each patient using a 1 ml tuberculin syringe during cataract surgery at Tianjin Medical University Eye Hospital from January 2019 to August 2019.Sixteen samples from each group were selected for protein quantification and comparison by BCA method.The differentially expressed proteins between the two groups were analyzed using label-free liquid chromatography tandem mass spectrometry.The function and signal transduction pathways of differentially expressed proteins were further analyzed by Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes.Eighteen aqueous humor samples from each group were selected to verify the results of mass spectrometry by enzyme-linked immunosorbent assay (ELISA). This study protocol adhered to the Declaration of Helsinki.The use of human samples was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY[L]-40). Written informed consent was obtained from each patient prior to surgery.Results:The mean protein mass concentration of aqueous humor sample in the high myopic cataract group was (1 134.91±104.78) ng/L, which was significantly higher than that in the simple cataract group (706.71±85.43) ng/L, showing statistically significant difference ( t=11.977, P<0.01). A total of 463 proteins were identified and 86 proteins were found to be differentially expressed, including 49 up-regulated proteins and 37 down-regulated proteins in the two groups.These differentially expressed proteins were mainly protein-binding activity modulator, extracellular matrix protein, carrier protein, intercellular signal molecule, protein modifying enzyme and so on, accounting for 32.70%, 14.50%, 9.10%, 9.10% and 7.30%, respectively.Bioinformatics analysis showed that 86 differentially expressed proteins were mainly related to biological processes such as complement activation and regulation, acute inflammatory response, and extracellular matrix tissue remodeling.Among them, 21 differentially expressed proteins were enriched in the complement and coagulation cascades pathways, 15 in the extracellular matrix-receptor interaction pathway, and 8 in the PI3K-Akt signaling pathway.ELISA results showed that the expression trends of three randomly selected differentially expressed proteins of the two groups were consistent with the results of label-free quantitative proteomic analysis. Conclusions:There are significant changes in proteomic profiles of aqueous humor between the high myopia cataract patients and simple cataract patients.High myopia is closely associated with inflammation and immune interactions, and remodeling of extracellular matrix.

As one of the main causes of low vision and blindness in the world, high myopia has become increasingly serious and caused heavy economic and social burden.However, its pathogenesis is complex and has not been fully clarified yet.In recent years, with the continuous progress of biological technology, proteomic technology has been used to find differentially expressed functional proteins in animal models and tissues of high myopic patients in order to obtain specific biological markers related to high myopia, and to provide new insights for exploring the pathogenesis, diagnosis methods and treatment of high myopia.In this article, the clinical characteristics of high myopia, the research content and strategies of proteomics, the research progress of proteomics in high myopia studying eye tissues of model animals and the blood, lens and aqueous humor of patients were reviewed, the outstanding advantages and achievements of proteomic technology in the study of high myopia were analyzed, and the pathological mechanism of high myopia was explored from the perspective of functional proteins, which would provide a theoretical basis for the development of specific molecular drugs with therapeutic value.

Radiation therapy plays an important role in the adjuvant treatment of patients with early endometrial carcinoma. Vaginal stump is a common site of disease failure for early endometrial carcinoma patients with intermediate-high risk factors for recurrence. Compared with external beam radiotherapy, vaginal brachytherapy (VBT) can achieve comparable local control rate with fewer toxicities. In this article, research progresses upon the application of VBT in patients with early endometrial carcinoma after hysterectomy were investigated from multiple perspectives of the selection of patients, the selection of vaginal applicator, factors influencing dose distribution, image-guided adaptive brachytherapy, the design and implementation of radiotherapy regime. In addition, the application of intensity-modulated VBT and the usage of novel quality assurance equipment were also discussed.

Objective To observe the effect of different macular edema on the area of foveal avascular zone (FAZ) and its correlation in eyes with branch retinal vein occlusion (BRVO).Methods A total of 72 patients (75 eyes) diagnosed with BRVO were included in the study.There were 40 patients males (42 eyes) and 32 females (33 eyes),with the mean age of (56.00±9.96) years.All the eyes were examined by BCVA,intraocular pressure,slit lamp microscope combined with preset lens,fundus color photography and optical coherence tomography angiography (OCTA).BRVO patients were divided into two groups according to the degree of macular edema:group M300 that was CRT ≥300 μm (38 patients,39 eyes) and group L300 that was CRT＜300 μmn (34 patients,36 eyes).The macular angiography scan protocol covered a 3 mm × 3 mm area.The parameters of macular were measured by the built-in measurement software of the system:(1) area of FAZ,perimeter ofFAZ (PERIM),avascular index ofFAZ (AI),vascular density within a width of 300 μm around the FAZ region (FD-300);(2) central retinal thickness (CRT);(3) vascular density (VD):the superficial central fovea vascular density (SFVD),the deep central fovea vascular density (DFVD),the superficial hemi-macular vascular density (SHVD),the deep hemi-macular vascular density (DHVD).Spearman test was used to test the correlation between FAZ area and other parameters in each group.Results The FAZ area in group M300 and L300 were 0.388 ± 0.166 mmn2 and 0.596± 0.512 rmm2,respectively.The results of Spearman test showed that the FAZ area of group M300 was positively correlated with PERIM and AI (r=0.932,0.591;P=0.000,0.000),negatively correlated with SFVD,DFVD and SHVD (r=-0.490,-0.429,-0.339;P=0.002,0.006,0.035).But there was no significant negative correlation between FAZ area and FD-300,CRT,DHVD in group M300 (r=-0.129,-0.053,-0.400;P=0.435,0.749,0.395).The FAZ area in group L300 was positively correlated with PERIM and AI (r=0.887,0.633;P=0.000,0.000),negatively correlated with SFVD,DFVD,SHVD and DHVD (r=-0.413,-0.643,-0.630,-0.370,-0.411;P=0.012,0.000,0.000,0.026,0.013).But there was no significant positive correlation between FAZ area and FD-300 in group L300 (r=0.093,P=0.590).Conclusion FAZ area varies with the degree of macular edema.The degree of macular edema is higher,the FAZ area is smaller.FAZ area is positively correlated with PERIM and AI significantly,and negatively correlated with SFVD,DFVD and SHVD.