AIM: To evaluate the safety and efficacy of allogeneic intrastromal lenticule implantation combined with corneal collagen cross-linking(CXL)in patients with moderate to advanced keratoconus.METHODS: A retrospective case series analysis was conducted. A total of 19 patients(20 eyes)with moderate to advanced keratoconus who underwent combined allogeneic intrastromal lenticule implantation and CXL at the Jinan Mingshui Eye Hospital from June 2021 to December 2023 were included. The uncorrected distance visual acuity(UCVA), thinnest corneal thickness, central corneal epithelial thickness, anterior corneal flat keratometry(Kf), steep keratometry(Ks), and mean keratometry(Km), as well as the first applanation time(A1T), the first applanation length(A1L), the velocity during the first applanation moment(VIN), the second applanation time(A2T), the second applanation length(A2L), the velocity during the second applanation moment(VOUT), highest concavity time(HCT), highest concavity radius(HCR), peak distance(PD), deformation amplitude(DA), stiffness parameter at first applanation(SP-A1), integrated radius(IR), central corneal thickness(CCT), intraocular pressure(IOP), corneal thickness-corrected IOP, biomechanically intraocular pressure IOP(bIOP), and corneal thickness variation rate(ARTH)were compared between the two groups before surgery and at 1 wk, 1, 3 and 6 mo after surgery.RESULTS: All patients successfully completed the surgery without any intraoperative complications. No significant differences were observed between pre-operative and post-operative measurements for UCVA or the corneal biomechanical parameters, including A1L, A2L, PD, A1T, A2T, VIN, VOUT, DA, IOP, and bIOP(all P>0.05). Significant differences were found between pre-operative and post-operative values for corneal thinnest point thickness, central corneal epithelial thickness, Kf, Ks, Km, and the corneal biomechanical parameters, including HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.05). The anterior corneal curvature demonstrated an initial increase followed by a decrease post-operatively. Furthermore, significant differences were observed between pre-operative and post-operative values for HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.005).CONCLUSION: Allogenic intrastromal lenticule implantation combined with corneal collagen cross-linking demonstrates favorable safety and stability in treating moderate-to-advanced keratoconus. This combined procedure effectively increases corneal thickness and rigidity, resulting in corneas that are more resistant to deformation postoperatively.

Objective:To evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on tourniquet-induced hypertension (TIH) in the patients undergoing anterior cruciate ligament reconstruction.Methods:Seventy-four patients of either sex, aged 18-60 yr, of American Society of Anesthesiologists Physical Status classification I or II, with body mass index of 18-30 kg/m 2, undergoing elective anterior cruciate ligament reconstruction under general anesthesia combined with preoperative femoral nerve block, were divided into 2 groups ( n=37 each) using a random number table method: sham stimulation group (group SS) and group taVNS. Group SS received stimulation on the ear lobe and the tail of the helix of the left ear. Group taVNS received stimulation on the cymba concha and the earlobe of the left ear. Both groups received stimulation from 1 h before induction of anesthesia until the end of the procedure (frequency of 30 Hz, pulse width of 300 μs, and amplitude of the strongest current that could be tolerated by the patient in the absence of pain). The tourniquet inflation pressure was 280 mmHg, with an inflation time of 60-90 min. Systolic blood pressure, diastolic blood pressure and heart rate were recorded before tourniquet inflation to assess the development of intraoperative TIH. The consumption of intraoperative propofol, remifentanil, nitroglycerin, esmolol, norepinephrine and atropine was recorded, and the occurrence of postoperative nausea and vomiting, skin itching and headache and dizziness was also recorded. Results:Compared with group SS, the incidence of TIH and the number of patients used nitroglycerin were significantly reduced ( P<0.05), and no significant changes were found in the other parameters in group taVNS ( P>0.05). Conclusions:taVNS can decrease the occurrence of TIH in the patients undergoing anterior cruciate ligament reconstruction.

Keratoconus is a progressive disease that seriously affects the eyesight of young people. Keratoconus often causes high myopia, irregular astigmatism, and some patients with advanced corneal scar, visual acuity significantly decreased. In the course of diagnosis and treatment of keratoconus, refractive reconstruction of keratoconus is the focus of clinical attention. After years of research and exploration, a variety of treatment methods in different stages of disease(non-progressive, progressive, advanced)for keratoconus patients refractive reconstruction, so that they can obtain good visual function. This paper mainly reviews the refractive reconstruction schemes of keratoconus in different periods, analyzes the advantages and disadvantages of various treatment schemes at home and abroad, and summarizes the characteristics of different treatment methods, with a view to providing theoretical reference and new treatment ideas for the diagnosis and treatment of keratoconus.

Objective To investigate the effect of radiation on cardiomyocyte apoptosis and its related mechanism.Methods Rat H9C2 cardiomyocytes were divided into blank control group,X-ray irradiation group(X-ray group),X-ray irradiation+microRNA(miRNA)-134-5p inhibitor group(X-inhibitor group)and X-ray irradiation+miRNA-134-5p inhibitor negative control group(X-NC group).H9C2 cardiomyocytes were irradiated with 6 Gy X-ray,and the changes of various indexes were detected 48 h after irradiation.Cell viability was detected by cell counting kit 8 assay.The apoptosis rate was detected by flow cytometry and Hoechst 33342 staining.The level of reactive oxygen species(ROS)in cells was detected by DCFH-DA fluorescence probe.The mitochondrial membrane potential was detected by JC-1 method.The activity of superoxide dismutase(SOD)and the level of malondialdehyde(MDA)in cells were measured by kits.The expression of miRNA-134-5p was detected by quantitative polymerase chain reaction.The protein expression of brain-derived neurotrophic factor(BDNF),protein kinase B(Akt),phosphorylated Akt(p-Akt),Bcl2 and Bax was detected by Western blotting.Results Compared with the blank control group,in the X-ray group the levels of ROS and MDA were significantly increased,the activity of SOD was significantly decreased,the decreased percentage in mitochondrial membrane potential was significantly increased,the number of micronuclei of DNA damage was significantly increased,and the apoptosis rate was significantly increased(all P＜0.01).Compared with the X-ray group,all the indexes of the X-inhibitor group were reversed(P＜0.05 or P＜0.01),while there was no significant difference in the above parameters in the X-NC group(all P＞0.05).Compared with the blank control group,the X-ray group had a significant increase in the miRNA-134-5p level and significant reductions in the protein level of BDNF,Bcl2/Bax ratio,and p-Akt/Akt ratio(all P＜0.01).Compared with the X-ray group,the X-inhibitor group had a significant reduction in the level of miRNA-134-5p and significant increases in the protein level of BDNF,Bcl2/Bax ratio,and p-Akt/Akt ratio(all P＜0.01),and there was no significant difference in all parameters in the X-NC group(all P＞0.05).Conclusion X-ray irradiation can induce oxidative stress,mitochondrial damage,and DNA damage,eventually leading to apoptosis in rat cardiomyocytes,and the mechanism may involve miRNA-134-5p/BDNF/Akt signaling pathway.

Objective:To investigate the influence of long-term wear of soft contact lenses on corneal transparency.Methods:A cross-sectional study was conducted.The corneal optical density of female myopic patients who planned to undergo corneal refractive surgery in Jinan Mingshui Eye Hospital from January 2018 to December 2020 was examined.The patients were divided into ≥2-<5 years group, ≥5-<10 years group, and ≥10 years group according to the duration of wearing contact lenses.Age- and sex-matched patients without wearing soft contact lenses were enrolled as a control group.There were 50 eyes from 50 cases in each group.The cornea was divided into 0-2, 2-6, 6-10, and 10-12 mm corneal vertex-centered annuli.The cornea over each annulus was divided into a superficial layer (≤120 μm from the outer surface of the cornea), a deep layer (≤60 μm from the inner surface of the cornea) and a central layer (between the superficial and deep layers). Measurements of the right eye were taken for analysis.The corneal optical density of different layers over different corneal ring regions was compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Jinan Mingshui Eye Hospital (No.2018-005). Written informed consent was obtained from each subject before any medical examination.Results:The corneal optical density tended to decrease as the wearing duration of corneal contact lens extended.The corneal optical density values of control group, ≥2-<5 years group, ≥5-<10 years group, and ≥10 years group were 18.51±1.79, 18.25±2.10, 18.16±1.89 and 17.83±1.65, respectively, showing no significant difference ( F=1.152, P=0.329). There was no significant difference in the corneal optical density of the superficial layer over 0-2, 2-6, and 6-10 mm annuli among the four groups ( F=2.077, 2.080, 2.229; all at P>0.05). There was a significant difference in the corneal optical density of the superficial layer over 10-12 mm annulus among the four groups ( F=5.016, P=0.002), and the corneal optical density of the superficial layer was greater in ≥5-<10 years group than in ≥2-<5 years, and greater in ≥10 years group than in control group, showing statistically significant differences (both at P<0.05). There were significant differences in the corneal optical density of the central layer over 0-2 and 6-10 mm annuli ( F=3.808, 2.813; both at P<0.05), and the corneal optical density of the central layer was lower in ≥10 years group than in control group, showing a statistically significant difference ( P<0.05). There were significant differences in the corneal optical density of the deep layer over 0-2, 2-6, 6-10 and 10-12 mm annuli ( F=5.485, 5.625, 3.398, 2.775; all at P<0.05). The optical density of the deep layer was lower in ≥5-<10 years than in control and ≥2-<5 years groups over 0-2, 2-6, and 10-12 mm annuli, lower in ≥5-<10 years group than in control group over the 6-10 annulus, and lower in ≥10 years group than in control group over 0-2, 2-6, and 6-10 mm annuli, and the differences were statistically significant (all at P<0.05). Conclusions:For women, the long-term wear of soft contact lenses for 5 years does not affect corneal transparency, and long-term wear for more than 5 years can cause a decrease in the transparency of the superficial peripheral cornea.

Platycodon grandiflorus polysaccharide (PGP) is one of the main components of P. grandiflorus, but the mechanism of its anti-inflammatory effect has not been fully elucidated. The aim of this study was to evaluate the therapeutic effect of PGP on mice with dextran sodium sulfate (DSS)-induced ulcerative colitis (UC) and explore the underlying mechanisms. The results showed that PGP treatment inhibited the weight loss of DSS-induced UC mice, increased colon length, and reduced DAI, spleen index, and pathological damage within the colon. PGP also reduced the levels of pro-inflammatory cytokines and inhibited the enhancement of oxidative stress and MPO activity. Meanwhile, PGP restored the levels of Th1, Th2, Th17, and Treg cell-related cytokines and transcription factors in the colon to regulate colonic immunity. Further studies revealed that PGP regulated the balance of colonic immune cells through mesenteric lymphatic circulation. Taken together, PGP exerts anti-inflammatory and anti-oxidant effect and regulates colonic immunity to attenuate DSS-induced UC through mesenteric lymphatic circulation.
Animals ; Mice ; Colitis, Ulcerative/drug therapy* ; Platycodon ; Colon/pathology* ; Cytokines ; Anti-Inflammatory Agents/therapeutic use* ; Polysaccharides/therapeutic use* ; Dextran Sulfate ; Disease Models, Animal ; Colitis/chemically induced* ; Mice, Inbred C57BL

Objective:To explore the effect of continuing care based on timing theory in the postoperative rehabilitation of patients with ectopic pregnancy.Methods:Using the convenient sampling method, a total of 86 patients with ectopic pregnancy who were admitted to Department of Obstetrics and Gynecology of the Anhui No.2 Provincial People 's Hospital were selected as the research objects from November 2018 to November 2020. According to the random number table method, they were divided into the observation group and the control group, with 43 cases in each group. The patients in the control group were given routine care and follow-up, and patients in the observation group implemented the continuing care based on timing theory on the basis of the control group. The Exercise of Self-Care Agency Scale (ESCA) , Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, nursing satisfaction and the incidence of complications were compared between the two groups at the time of admission and one month after discharge. Results:The scores of all dimensions in the ESCA of the observation group were higher than those of the control group, and the differences were statistically significant (all P<0.05) . The SAS and SDS scores of the observation group were lower than those of the control group, and the differences were statistically significant (all P<0.05) . The incidence of complications in the observation group was 4.65% (2/43) , which was lower than 18.60% (8/43) in the control group, and the difference was statistically significant ( P<0.05) . The satisfaction of nursing care of patients in the observation group was 95.35% (41/43) , which was higher than 81.40% (35/43) of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The implementation of transitional care under the guidance of timing theory for patients after ectopic pregnancy can achieve good rehabilitation effects and improve the self-care ability of patients, which is worthy of clinical promotion.

Objective:To evaluate the impact of laparotomy pancreatoduodenectomy (OPD), laparoscopic pancreatoduodenectomy (LPD) and Da Vinci robot assisted pancreatoduodenectomy (RPD) on the risk of pancreatic fistula in postoperative patients.Methods:The key words were laparoscopic, pancreaticoduodenectomy, robot, DaVinci, Whipple, complication, fistula, pancreaticoduodenectomy, laparoscopy, robot, postoperative complications and pancreatic fistula, and the databases of CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, EMBASE and web of science were searched until August 1, 2020 for retrospective cohort studies and randomized controlled trials comparing the efficacy of OPD, LPD and RPD. The articles were screened according to the pre-set inclusion and exclusion criteria, and the quality of the articles was evaluated and the data were extracted. Based on Bayesian framework, R4.0.2, Revman 5.3 and Stata 16.0 software were used to analyze the extracted data for mesh meta analysis.Results:Thirty articles involving 3 428 patients were included, including 26 retrospective cohort studies and 4 randomized controlled studies. Mesh meta-analysis showed that in the incidence of pancreatic fistula, there was no significant difference between LPD and OPD, between LPD and RPD ( OR=0.93, 95% CI 0.63-1.4; OR=1.4, 95% CI 0.87-2.2, P<0.05), but the incidence of postoperative pancreatic fistula was significantly lower than that of OPD ( OR=1.5, 95% CI 1.1-2.1, P<0.05), 95% CI 1.12.1; P>0.05). The risk probability of pancreatic fistula was ranked as RPD (0.00), LPD(0.34) and OPD(0.65), that is, for the risk of postoperative pancreatic fistula, the advantages and disadvantages of the three surgical methods were ranked as RPD, LPD and OPD. Conclusions:Compared with OPD, RPD can significantly reduce the risk of pancreatic fistula after PD and improve the quality of operation; there was no significant difference between LPD and RPD in the incidence of postoperative pancreatic fistula, and both of them were safe and feasible.

Objective:To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia.Methods:A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO 2)/arterial partial pressure of oxygen (PaO 2)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded. Results:A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type Ⅱ respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO 2) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO 2 decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups. Conclusion:Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO 2 decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.

Objective:To observe the effect of arsenic trioxide (ATO) on the expression of NKG2D ligand UL16 binding protein 1(ULBP1) in acute myeloid leukemia KG1a cells, and explore the molecular mechanism for its regulation of ULBP1 expression.Methods:KG1a cells were cultured in vitro.Then, the inhibition of KG1a cell proli-feration by different concentrations of ATO was detected by cell counting kit-8(CCK8) assay, and the expression of ULBP1 mRNA and surface protein in KG1a cells were examined by real-time RT-PCR and flow cytometry, respectively.After that, the blocking effects of ataxia telangiectasia mutated and RAD3-related kinase (ATM/ATR) inhibitor caffeine on ATO-upregulated expression of ULBP1 mRNA and surface protein expressions were investigated, and the effects of ATO on the expression of CHK1 and CHK2 proteins and their phosphorylation in KG1a cells were observed by Western blot method. Results:Different concentrations (1, 2, 3, 4, 5 μmol/L) of ATO could inhibit the proliferation of KG1a cells, which was concentration dependent, and the half inhibitory (IC 50) concentration to KG1a cells was 2.7 μmol/L.The expression of ULBP1 mRNA on KG1a cells were increased when incubated with ATO at concentration 1, 2, 3, 4, 5 μmol/L, compared without ATO group, ULBP1 mRNA expression level relatively increased respectively to (1.86±0.30) times, (3.02±0.71) times, (3.16±0.75) times, (4.80±0.70) times and (3.70±0.89) times, and the differences were statistically significant (all P<0.05). Furthermore, ATO (1, 2, 3, 4 and 5 μmol/L) upregulated ULBP1 protein expression on KG1a cells compared with that in the group without caffeine, and the differences were statistically significant (all P<0.05). After caffeine pretreat KG1a cell 2 h and ATO incubate KG1a cell 24 h, ULBP1 mRNA and protein expression levels were significantly reduced.When caffeine concentration was 8 mmol/L, ULBP1 mRNA expression level relatively reduces from (9.55±0.38) times to (6.36±0.93) times compared with that in the group without caffeine, and the difference was statistically significant ( P<0.05). When caffeine concentration was 2, 4 and 8 mmol/L respectively, the expression of ULBP1 protein was reduced from that in the group without caffein treatment (3.50±0.08) times to (2.17±0.07) times, (2.02±0.06) times and (1.75±0.06) times, respectively, and the differences were statistically significant (all P<0.05). The expression of CHK1 and CHK2 proteins decreased with the increase of ATO concentration, while p-CHK1 and p-CHK2 are increased as ATO. Conclusions:ATO upregulate the expression of ULBP1 mRNA and protein in KG1a cells, and the ATM/ATR-CHK1/CHK2 pathway may be involved in it.