AIM: To investigate the effects of placement of the absorbable packing material Nasopore around the anastomosis site on postoperative re-bleeding, discomfort, and on the success rate of endoscopic dacryocystorhinostomy(En-DCR).METHODS: Prospective randomized controlled study. A total of 101 patients(101 eyes)diagnosed with chronic dacryocystitis that underwent En-DCR in the ophthalmology department, Renmin Hospital, Hubei University of Medicine from November 2020 to October 2021 were collected. The patients were randomly divided into two groups according to whether they were packed with Nasopore at the end of operation, namely, the packed group(49 eyes)and the non-packed group(52 eyes). The postoperative follow-up was 9 mo, the degree of re-bleeding, discomfort, and postoperative success rate(including anatomical success rate and functional success rate)were compared between the two groups of patients.RESULTS: This study included 94 patients, including 45(45 eyes)and 49(49 eyes)in packed group and non-packed group, respectively. The En-DCR was performed successfully in all patients. Postoperative re-bleeding occurred in 1 eye(2%)in the packed group, and 9 eyes(18%)in the non-packed group(P<0.05); postoperative nasal discomfort occurred in 2 cases(4%)in the packed group, and 9 cases(18%)in the non-packed group(P<0.05); The success rate of postoperative anatomical success rate was 93%(42/45)in the packed group and 88%(43/49)in the non-packed group(P>0.05). The postoperative functional success rate was 89%(40/45)in the packed group and 86%(42/49)in the non-packed group(P>0.05). Other complications such as orbital fat prolapse, cerebrospinal fluid leakage, sinusitis, visual impairment and double vision were not observed in all patients during the follow-up.CONCLUSION: Nasal packing absorbable material Nasopore around the anastomosis at the end of En-DCR operation can reduce postoperative re-bleeding and postoperative discomfort of patients, and it has no obvious effect on the postoperative success rate.

ObjectiveTo comprehensively assess the clinical value of Duliang soft capsules in the treatment of migraine with wind-cold blood stasis syndrome， and to provide guidance for national medical decision-making， clinical drug promotion， and pharmaceutical services. MethodThe evaluation of Duliang soft capsules' clinical value was conducted in accordance with the Guidelines for the Management of Comprehensive Clinical Evaluation of Drugs （Trial Version， 2021） using a combination of qualitative and quantitative methods. Utilizing the CSC v2.0 software， this study conducted a comprehensive clinical evaluation of Duliang soft capsules across the "6+1" dimensions， including safety pre- and post-market launch， effectiveness in treating migraine， economy （cost-effectiveness）， and innovation， suitability， accessibility， and traditional Chinese medicine （TCM） characteristics in both its technology and clinical applications. ResultSafety： Duliang soft capsules were found to have good safety based on evidence from known adverse reactions （spontaneous reporting system （SRS） data， literature data， etc.）， pre-marketing toxicological research， and post-marketing drug monitoring. Effectiveness： A meta-analysis indicated that the combination of Duliang soft capsules and western medicine was more effective than Western medicine alone in the treatment of migraine. The product's effectiveness was rated as "Best" based on the quality and value of the evidence. Economy： Duliang soft capsules are moderately priced and categorized as a Type B medical insurance product. Economic research indicated that the combination of Western medicine and Duliang soft capsules was more cost-effective than Western medicine alone. The product's economy was rated as "Better". Innovation： Duliang soft capsules， with Angelicae Dahuricae Radix and Chuanxiong Rhizoma as the main components， hold one invention patent and have been awarded the China Patent Excellence Award. The pharmaceutical company has introduced innovative extraction （CO₂ supercritical extraction technology） and formulation （soft capsule） processes. The product's innovation was rated as "Better". Suitability： A questionnaire survey on Duliang soft capsules showed that it was well-suited for both patients and healthcare professionals. The product received a comprehensive assessment of suitability through the "Evaluation of Chinese Patent Medicine Information Services". The product's suitability was rated as "Best". Accessibility： Duliang soft capsules are moderately priced， making them accessible and affordable. The product's accessibility was rated as "Good" based on evidence from these three aspects. TCM characteristics： The formulation of Duliang soft capsules can be traced back to WANG Qiu's Selected Formulas from the Praiseworthy Studio （Shi Zhai Bai Yi Xuan Fang） from the Song Dynasty， and it was documented in ZHANG Jiebin's The Complete Works of Zhang Jing-yue （Jing Yue Quan Shu） as "Duliangwan". The product has been extensively studied with over 2000 clinical cases since its market launch， and its TCM characteristics were rated as outstanding with sufficient evidence. ConclusionThe comprehensive clinical value evaluation of Duliang soft capsules demonstrated its high effectiveness， suitability， and accessibility， and outstanding TCM characteristics. The product's safety， economy， and innovation received good ratings. In summary， Duliang soft capsules exhibited significant clinical value and outstanding TCM characteristics， the evidence was sufficient， and the result was confirmed， providing crucial references for clinical decision-making and pharmaceutical management.

Objective:To verify the synthetic CT(sCT) images generated by the adaptive radiation therapy (ART) workflow guided by magnetic resonance imaging (MRI), and to evaluate its feasibility for dose calculation in ART for head and neck.Methods:The plan CT (pCT) and T 2WI MRI images before each fraction of treatment were collected from 300 patients with head and neck tumors admitted to Shandong Cancer Hospital from January 1, 2022 to December 1, 2023. MRI was converted into sCT using RegGAN model. Among 300 patients, 240 cases were used for training and validation and 60 for testing. The mean absolute error (MAE), peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) were used to evaluate the image quality of sCT. The original pCT plan conditions were copied to sCT, and the accuracy of sCT was recalculated and verified. Finally, the radiation treatment plan of sCT was verified, and the γ-passing rate was calculated to further verify the accuracy of sCT dose calculation. Results:In terms of index calculation, the MAE of sCT was 32.50±5.46, 31.39±1.14 for PSNR, and 0.93±0.01 for SSIM, respectively. Slight difference was observed in the comparison of CT values. Regarding dose calculation, the accuracy of sCT dose calculation was high. According to the dose volume histogram (DVH), the difference in dose calculation was slight, and the average dose difference was only 0.16%. sCT exhibited a high degree of coincidence with pCT in the evaluation of target delineation for planning target, clinical target and gross tumor volume. The average Dice similarity coefficients were 0.97, 0.95 and 0.94, respectively. The γ-passing rate reached 100% using 3%/2 mm. The total treatment time of all patients was (155.14±9.41) s.Conclusions:The ART workflow has high work efficiency, and the accuracy of the generated sCT can meet the dose calculation accuracy requirements of the online plan. It can be used as a reference image for MRI-guided accelerator ART of nasopharyngeal carcinoma, and is expected to achieve MR radiotherapy based on nasopharyngeal carcinoma.

Objective:To investigate the pathogenesis, selection of endovascular treatment (EVT) strategies, and efficacies of acute vertebrobasilar artery occlusion (AVBAO) of different lesion sites.Methods:One hundred and five patients with AVBAO, admitted to and accepted EVT in our hospital from February 2017 to September 2019, were chosen in our study. The data of disease onset, imaging findings, EVT status, perioperative complications, and prognoses of these patients were collected. According to DSA results, the involved lesions were divided into 4 sites: the upper segment of basilar artery (BA), the middle segment of BA, the lower segment of BA, and the intracranial segment of vertebral artery (V4 segment), and patients with tandem lesions would be recorded as distal lesions. The risk factors, EVT strategies, and prognoses 90 d after follow-up (modified Rankin scale [mRS] scores≤3: good prognosis) were compared in patients with 4 different lesion sites.Results:There were significant differences in etiological classifications and percentage of patients combined with atrial fibrillation among patients with 4 different lesion sites ( P<0.05). There was significant difference in proportion of patients accepted emergency stent implantation among patients with 4 different lesion sites ( P<0.05): those with lesions at the V4 segment had the highest proportion of patients accepted emergency stent implantation (79.55%), followed by those with lesions at the lower segment of BA (50.00%). There was significant difference in EVT time (the time from arterial puncture to successful recanalization of occluded vessels) among patients with 4 different lesion sites ( P<0.05): the EVT time in patients with lesions at the middle segment of BA was the shortest (87.5 [58.5, 130.8] min), and the EVT time in patients with lesions at the lower segment of BA was the longest (115.0 [81.0, 163.0] min). There was no statistical difference among patients with different lesion sites in good prognosis rate 90 d after follow-up ( P>0.05). Conclusion:The pathogenesis of patients with different AVBAO lesion sites is different, so different EVT strategies should be adopted.

Objective:To investigate the predictive value of neutrophil-lymphocyte ratio (NLR) for Trousseau’s syndrome (TS) in patients with acute multiple cerebral infarctions (AMCI).Methods:The patients with AMCI in Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine from July 2013 to March 2022 were retrospectively enrolled. The demographic and baseline clinical data of patients with TS and those without TS were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of TS-AMCI, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of NLR for TS-AMCI. Results:A total of 59 patients with AMCI were enrolled, including 43 males and 16 females, aged 64.9±14.0 years. There were 16 patients in the TS-AMCI group and 43 in the non-TS-AMCI group. The proportions of patients with diabetes mellitus, hypertension and previous stroke or transient ischemic attack in the TS-AMCI group were significantly lower than those in the non-TS-AMCI group (all P<0.05), while the proportion of patients with ischemic heart disease were significantly higher than that in the non-TS-AMCI group ( P<0.05). The proportion of patients with bilateral infarction in the TS-AMCI group was significantly higher than that in the non-TS-AMCI group ( P<0.001). The D-dimer, NLR, white blood cell count, neutrophil count, monocyte count, percentage of neutrophils, total cholesterol and low-density lipoprotein cholesterol in the TS-AMCI group were significantly higher than those in the non-TS-AMCI group (all P<0.001), while the lymphocyte count, lymphocyte percentage, red blood cell count, hemoglobin and hematocrit were significantly lower than those in the non-TS-AMCI group (all P<0.001). Multivariate logistic regression analysis showed that high NLR was an independent predictor of TS-AMCI (odds ratio [ OR] 2.897, 95% confidence interval [ CI] 1.270-6.527; P=0.011), while high hemoglobin was independently negatively correlated with TS-AMCI ( OR 0.839, 95% CI 0.723-0.975; P=0.022). ROC curve analysis showed that the area under the curve of NLR for predicting TS-AMCI was 0.929 (95% CI 0.831-0.979; P<0.001). When the NLR cutoff value was 4.01, the corresponding Youden index was 0.744. At this time, the sensitivity and specificity were 100% and 74.42% respectively. Conclusion:NLR has high predictive value for TS-AMCI.

Objective:To investigate the influence of low-dose ionizing radiation on the expression level of serum insulin-like growth factor binding protein-3 (IGFBP-3) in radiation workers in hospitals.Methods:183 radiation workers were randomly selected and grouped by work type including interventional radiology ( n=37), nuclear medicine ( n=43), radiotherapy ( n=48), and diagnostic radiology ( n=55). The content of IGFBP-3 in the serum of radiation workers was detected by ELISA assay. Results:It was observed that the expression level of serum IGFBP-3 in the four groups had significant differences ( F=6.056, P<0.05), and the content of serum IGFBP-3 in the interventional radiology group was significantly higher than that of nuclear medicine, radiotherapy, and diagnostic radiology groups ( t= 2.815, 3.611, 3.936, P<0.05). The concentration of IGFBP-3 in the serum of radiation workers among different annual effective dose groups was statistically different ( F=8.380, P<0.05), which gradually increased with the increase of annual effective dose and length of service ( rs=0.202, 0.151, P<0.05). Conclusions:The expression level of serum IGFBP-3 has the potential to be used as a biomarker to reflect the cumulative exposure of long-term chronic low-dose ionizing radiation.

Objective:To investigate the efficacy and safety of endovascular recanalization treatment for acute vertebral basilar artery occlusion (AVBAO) underlying intracranial atherosclerotic disease (ICAD) using a balloon-mounted stent.Methods:A total of 16 cases of consecutive AVBAO patients who underwent endovascular treatment with the balloon-mounted stent within 24 h after onset were retrospectively enrolled in Henan Provincial People′s Hospital from February 2017 to August 2019. And the recanalization rate, operation-related complications, symptomatic intracranial hemorrhage, the improvement of 1 week National Institutes of Health Stroke Scale (NIHSS) score and 3 months modified Rankin Scale (mRS) after treatment were recorded.Results:In all of the 16 patients, 4 patients underwent direct stenting angioplasty, 12 patients received salvage stenting. Stent placement was successful in all 16 patients. Balloon-mounted stent were implanted in basilar artery of 4 cases, in intracranial segment of vertebral artery of 8 cases, and in origination segment of vertebral artery of 4 cases. Recanalization was successful (thrombolysis in cerebral infarction grade 2b and 3) in 15 patients. The time between arterial puncture and recanalization was 79.0 (72.3, 109.3) min. One patient experienced distal thrombosis during surgery. Two patients suffered symptomatic intracranial hemorrhage within 48 h after surgery. The scores of the NIHSS were improved more than 4 points at 1 week after operation in 8 patients. At 3 months follow-up, 9 patients had a good outcome (mRS 0-3 points) and 4 patients died.Conclusion:Selective stenting angioplasty treatment with a balloon-mounted stent seems to be feasible and safe for AVBAO patients underlying ICAD.

Objective This retrospective study compared the detection rates of prostate cancer between freehand transperineal biopsy (FTPB) and template-guided transperineal biopsy (TYPB) in the patients with PSA levels ＜ 20 ng/ml.Methods From April 2017 to April 2019,768 patients with PSA levels ＜ 20 ng/ml were included into this study.Of these patients,406 underwent FTPB procedures and 362 underwent TTPB procedures.There were no significant differences of median age [66.00(61.00,70.00)vs.66.00 (61.00,71.25) years],height [170.00 (165.00,172.00) vs.170 (165.00,173.00) cm],weight [70.00 (63.88,75.00) vs.70.00 (63.75,75.00) kg],BMI [24.22 (22.22,25.95) vs.24.22 (22.49,25.82) kg/m2],PSA [8.75 (6.49,12.40) vs.8.69 (6.49,11.96) ng/ml],fPSA [1.18 (0.33,2.15) vs.1.15(0.76,1.88)ng/ml],prostate volume [39.79(25.55,53.94)vs.39.88(24.46,55.11)ml] between two groups.Patients' biopsy results were recorded,the differences of prostate cancer detection rates between these two groups were analyzed,specifically including the cancer with Gleason score ≥ 7 and the anterior zone cancer.Results The total prostate cancer detection rates were 33.7％ (137/406) and 39.0％ (141/362,P =0.134) in FTPB group and TTPB group respectively,and the detection rates of cancer with Gleason score≥7 were 23.9％ (97/406) and 32.0％ (116/362,P =0.012) respectively.The detection rates of anterior zone prostate cancer were 15.5％ (63/406) and 27.3％ (99/362,P ＜0.001).Moreover,in thepatients with PSA ＜ 10 ng/ml,the prostate cancer detection rates were 29.8％ (74/248) and 36.2％ (81/224,P =0.144) respectively,while the detection rates of cancer with Gleason score ≥7 were 19.4％ (48/248) and 29.9％ (67/224,P =0.008) respectively.Conclusions There was no significant difference in the total prostate cancer detection rates between 12-core TTPB group and 20-core FTPB group in the patients with PSA ＜ 20 ng/ml,but for the detection rate of cancer with Gleason score ≥ 7,TTPB group was significantly higher than FTPB group,especially in the patients with PSA ＜ 10 ng/ml.In addition,for anterior zone prostate cancer,the detection rate of TrPB group was also higher than FTPB group.

Background The incidence of dry eye is increasing among young adults because of wide usage of video display terminal.But the early diagnosis of dry eye still presents challenge to medical practitioners.The accurate diagnosis and treatment of the dry eye,therefore,is a topic of high interest to researchers.Previous examination outcome of dry eye is interferred primarily due to invasive procedure.It is very important to search an examination approach.Objective This study was to use Keratograph 5M,a non-invasive ocular surface analyzer to evaluate the influence of watching video display terminal on ocular surface and tear film.Methods Eighty-one eyes of 81 health volunteers among 18-30 years were enrolled in Affiliated Eye Hospital of Nanchang University from March 1,2015 to November 10,2015 under the informed consent,including 39 males and 42 females.The subjects watched the computer for continuously 3 hours under the nature light,and ocular surface related examinations were performed and compared before and after video display terminal exposure,including non-invasive tear film break-up time (NITBUT),tear meniscus height,conjunctival hyperemia scoring,limbal congestion scoring,corneal fluorescein staining scoring,meibomian gland imaging and lipid layer analysis.Results The number of eyes with visual fatigue,dryness,pain,blurring and conjunctival congestion was significantly increased after 3-hour video display terminal exposure in comparison with before (all at P＜0.01).The initial NITBUT and mean NITBUT were (6.086± 3.701) s and (9.103 ± 4.680) s,and tear meniscus height was (0.190 ± 0.032) mm after trail,which were significantly lower than (11.445 ±4.964) s,(14.626 ±4.467) s and (0.212 ±0.040) mm of before trail,respectively;The conjunctical hyperemia scoring and limbal congestion scoring were 0.869 ±0.311 and 0.572 ±0.276 after trial,which were significantly higher than 0.780 ± 0.306 and 0.509 ± 0.266 before trail,showing significant differences before and after exposure of video display terminal (all at P＜0.01).The intraocular pressure and the eye number of different scores of corneal fluorescence staining,abnormal meibomian gland and different morphological lipid layer of tear were unchanged before and after exposure of video display terminal.Conclusions Long-term exposure of video display terminal results in significant and temporary adverse influence on tear film and ocular surface.Keratograph 5M non-invasive ocular sudace analyzer can objectively assess overall ocular surface conditions.

Objective To build rat DVT inferior vena cava partial stasis (narrow) model, to detected the expression ofβ2-GP1, VEGF and TF in rat blood, and to investigat the correlation betweenβ2-GP1, VEGF and TF with DVT. Meth?ods SD rats (n=70) are divided into control group (n=10), sham operation group (n=30) and the model group (n=30) ran?domly and DVT model was built by the inferior vena cava partial stasis (narrow) after 2 h, 8 h and 24 h respectively. In each time point, ten rats were taken in each group, inferior vena cava blood were collected whileβ2-GP1, VEGF and TF expres?sion were detected by ELISA. Results In rat experiment, compared with control group, there was no significant change in?expression of β2-GP1, VEGF and TF in sham operation group (P > 0.05). Levels of β2-GP1, VEGF and TF were in?creased at the 2nd hour and 8th hour then peak at the 24th hour which was higher than those in the 24th hour control group and in Sham group and it was also higher than those in the 2nd hour and the 8th hour in model group with statistical signifi?cant difference (P<0.01). Conclusion Based on the above experimental data, in rat DVT formation process, β2-GP1, VEGF and TF may play an important role in promote DVT formation.