AIM: To investigate the alterations in corneal aberration and relative refractive power following the reduction of back optic zone diameters(BOZD)of orthokeratology lenses.METHODS: Myopic children aged 8-12 years, deemed suitable and willing to wear orthokeratology lenses, were randomly allocated to wear lenses with a 6.0 mm BOZD or a 5.0 mm BOZD. Data collection included changes in higher-order aberrations, relative refractive power and the treatment zone diameter of the two groups after wearing lenses for 1 d, 1 wk, 1, and 3 mo. The correlation of increase in corneal higher-order aberrations with refractive power was analyzed.RESULTS: The increases in total higher-order aberrations, spherical aberrations and coma aberrations varied over time following lens wear(all P<0.001), and there were no statistically significant differences in the changes of total higher-order aberrations and coma aberrations between the two groups of patients(all P>0.05). A significant difference was observed in the increment of spherical aberrations in the 5 mm range between the two groups of patients, which varied over time(Ftime=40.179, Ptime<0.001; Fgroup=11.948, Pgroup=0.001; Finteraction=3.262, Pinteraction=0.03). A significant difference was observed in the increment of spherical aberrations in the 4 mm range between the two patient groups(Ftime=34.462, Ptime<0.001; Fgroup=13.094, Pgroup<0.001; Finteraction=1.372, Pinteraction=0.25). There was no statistically significant distinction in relative refractive power between the two groups(Fgroup=0.048, Pgroup=0.83; Finteraction=1.208, Pinteraction=0.31); however, relative refractive power changed over time(Ftime=40.030, Ptime<0.001). The difference in treatment zone diameter between the two groups was statistically significant, with changes over time(Ftime=11.212, Ptime<0.001; Fgroup=74.073, Pgroup<0.001; Finteraction=0.312, Pinteraction=0.82). The total higher-order aberrations, spherical aberrations, and coma aberrations in 4, 5 and 6 mm range showed a positive correlation with relative refractive power values(all P<0.001). Statistically significant difference was observed in the axial length between the two groups after wearing lenses for 3, 6 and 12 mo(Ftime=185.398, Ptime<0.001; Fgroup=5.618, Pgroup=0.02; Finteraction=2.315, Pinteraction=0.11).CONCLUSION: Orthokeratology lenses leaded to elevated higher-order aberrations. Orthokeratology lenses with smaller BOZD produced significantly greater spherical aberrations at 4 and 5 mm range and smaller treatment zone diameters. The corneal total higher-order aberration was positively correlated with relative refractive power. Wearing orthokeratology lenses with a smaller BOZD can cause slower axial growth and better myopia control.

This study included 116 professional postgraduate students majoring in clinical surgery who rotated in the Department of Breast and Thyroid Surgery of The First Affiliated Hospital of Army Medical University from 2019 to 2022. The students were provided with open online courses on precision medicine to build a strong theoretical foundation for evidence-based medicine; subsequently, precision medicine courses focusing on thyroid surgery were offered; and multidisciplinary team rounds for typical and difficult-to-diagnose cases were organized. Taking thyroid cancer as an example, questionnaire surveys and typical clinical case assessment were conducted to compare the scientific research and professional competencies of the students before and after evidence-based medicine education. The results showed that the students had significantly improved ability to use academic databases to acquire professional knowledge and solve problems, and showed increased enthusiasm in class, believing that the teaching content was easy to absorb and moderate in difficulty and the teaching effect was good.

Objective:To determine the relative correction factor of pre-vitamin D and simplify the calculation method of vitamin D assay.Methods:By studying the calculation method of vitamin D content in drug standards of various countries,HPLC was used to determine the relative correction factor of pre-vitamin D,and the influencing factors of determination were investigated.Results:The relative correction factors of pre-vitamin D at 254 nm and 265nm wavelength were determined by statistical analysis of 7 laboratories in China.Conclusion:Using the pre-vi-tamin D relative correction factor method to calculate the total amount of vitamin D simplified the experimental steps can be simplified by the pre-vitamin D relative correction factor method to calculate the total amount of vitamin D and the random operating errors can be avoided.The method is rapid and accurate,and lay a solid foundation for further improving the standard of vitamin D preparations.

As a high-level, applied, and specialized nursing professional, master of nursing specialist (MNS) postgraduates place great emphasis on the importance of clinical practice. Clinical practice helps to improve their clinical skills, identify clinical problems, and cultivate clinical research thinking. However, due to the late start of MNS education in China, there are still many problems in its clinical practice training, such as incomplete training programs, weak academic resources, and unclear self positioning. Based on this, this article reviews the current situation and influencing factors of clinical practice training for MNS postgraduates, and puts forward corresponding suggestions, in order to provide reference and guidance for optimizing the MNS postgraduate training program in China.

Objectives:To evaluate the strategy and clinical outcomes of reimplanting biventricular cardiac resynchronization therapy (Biv-CRT) devices after transvenous removal of coronary sinus left ventricular leads due to device-related infections. Methods:A retrospective analysis was conducted on the clinical data and surgical outcomes of all patients who underwent transvenous removal of infectious coronary sinus left ventricular leads and subsequent reimplantation of Biv-CRT devices at Peking University People's Hospital from January 2013 to December 2022.Follow-up was performed to assess the incidence of complications and all-cause mortality. Results:A total of 167 patients underwent coronary sinus left ventricular lead removal due to infection,removal was successful in 161 cases (96.4％) and failed in 6 cases (3.6％).Among the patients with successful removal,109 cases (67.7％) were scheduled for Biv-CRT device reimplantation.After a median time of 7 (5,7) days,6 cases (5.5％) of reimplantation failed,while 103 reimplantations (94.5％) were successful.Among these successful reimplantation cases,102 patients (99.0％) were through the right-side approach,and 1 case (1.0％) through the left-side approach due to bilateral pocket infections.Of the 161 patients with successful removal,58 cases (36.0％) did not undergo left ventricular lead reimplantation,including 39 cases (24.2％) where the initial indications for Biv-CRT were questionable or had resolved.During the one-year postoperative follow-up,among the 103 patients who had undergone Biv-CRT device reimplantation,7 patients (6.8％) died,1 patient (1.0％) experienced pocket infection,and 1 patient (1.0％) had right atrial lead dislodgment. Conclusions:Reimplantation of Biv-CRT devices after removal of coronary sinus left ventricular leads due to infections is feasible,with a high success rate,low complication rate,and low mortality rate for right-side approach implantation.Therefore,for patients re-evaluated to have indications for repeated Biv-CRT after lead removal,right-side reimplantation of the coronary sinus left ventricular lead should be recommended.

Objective To develop a whole course management information system for breast cancer and verify its effect in disease management of breast cancer patients.Methods An integrated service plan and system construction of"screening-diagnosis-treatment-rehabilitation"was developed,and then an information system was developed.The method of historical control was used to conveniently sample 260 cases of breast cancer patients diagnosed in a tertiary A hospital.130 cases diagnosed from May 1 to December 31,2022 were taken as a test group,and 130 cases diagnosed from May 1 to December 31,2021 were taken as a control group.The test group was managed by the whole course management information system,and the control group was managed by conventional disease management.The relevant indicators of the screening and diagnosis period of patients,the completion rate of treatment,the incidence of treatment related side effects and the cancer care satisfaction of the 2 groups were compared.Results There was a statistically significant difference in puncture waiting time,admission waiting time,and screening admission time between the 2 groups(P＜0.05),while there was no statistically significant difference in pathological waiting time(P＞0.05).The treatment completion rate of the test group was higher(P＜0.05).The incidence of lymphedema,chest obstruction and abnormal sensation of upper limbs,subcutaneous hydrops within 6 months after operation and bone marrow suppression,liver function damage,radiation dermatitis and radiation pneumonia in the test group were lower than those in the control group(P＜0.05).The cancer care satisfaction of the test group after surgery and 6 months after surgery were higher than those of the control group(P＜0.05).Conclusion The whole course management information system for breast cancer can optimize the diagnosis and treatment process,raise the diagnosis and treatment efficiency,ensure the treatment completion rate,reduce the treatment complications and improve the cancer care satisfaction.

Objective To analyze cognition,attitude,behavior status and influencing factor of neurological nurses for early rehabilitation of stroke.Methods A tatol of 182 neurological nurses from 8 tertiary hospitals in Urumqi were selected as the research subjects to investigate the cognition,attitude from December 2022 to June 2023,and behavior status of neurology nurses for early rehabilitation of stroke and analyze their influencing factors.Results The scores of 182 neurological nurses during early rehabilitation of stroke were(72.57士6.79),the scoring rate was 72.57％,which was in the middle level.The average score of attitude was(89.62±2.94),and the scoring rate was 89.62％,which was at a high level.The average score of behavior was(62.08±21.50),and the scoring rate was 62.08％,which was in the middle level.Multivariate regression analysis showed that age was the influence factor of nurses'early rehabilitation cognition dimension and attitude dimension(P＜0.05);The influence factors of nurses'early rehabilitation behavior were their professional title and whether stroke had occurred among relatives and friends(P＜0.05).Conclusion Neurological nurses have a positive attitude towards early rehabilitation of stroke,but they do not implement nursing measures enough.It is suggested that rehabilitation nursing training courses should be set up to encourage nurses to update their knowledge and strengthen their self-learning so as to improve nursing behavior and improve nursing quality.

Objective To observe the value of contrast-enhanced mammography(CEM)for differentiating benign and malignant breast lesions with calcifications.Methods Data of 116 female patients with 132 breast imaging reporting and data system(BI-RADS)category 4 to 5 lesions were retrospectively analyzed.The lesions were divided into malignant group(n=86)and benign group(n=46)according to the pathologic results.The morphological manifestations of calcification and their distributions were classified into high or low risk,and the combined risk typing of calcifications was assessed according to these two.Finally,an overall risk typing of CEM was obtained through combining the combined risk type of calcifications and accompanied enhancement or not.Then receiver operating characteristic(ROC)curves were drawn,the area under the curves(AUC)were calculated,and the efficacy of the above indexes for differentiating benign and malignant breast lesions with calcifications were evaluated and compared.Results Significant differences of morphology,distribution and accompanied enhancement were found between groups(all P＜0.05).The AUC of morphology risk,distribution risk,the combined risk of calcification,accompanied enhancement and CEM overall risk for differentiating benign and malignant breast lesions with calcifications was 0.709,0.678,0.774,0.800 and 0.875,respectively,of CEM overall risk was higher than that of the others(all P＜0.05).Conclusion CEM overall risk type obtained through integrating morphology and distribution manifestations of calcifications and enhancement type could improve the efficiency of CEM for differentiating benign and malignant breast lesions with calcifications.

Objective:To investigate the protein expression characteristics of bone metastatic breast cancer cells and the underlying molecu-lar mechanism driving bone metastasis.Methods:A firefly luciferase-overexpressing human breast cancer cell line,MCF-7-luc,and its bone metastasis subline,MCF-7-BOM-luc,were established.Additionally,a nude mouse model of breast cancer bone metastasis was established by injecting the aforementioned cells into the left ventricle.Bone metastasis and trabecular changes were assessed using micro-computed tomography(Micro-CT).Cell migration,and invasion were evaluated using the Transwell assays.Differential protein expression and epithelial-mesenchymal transition(EMT)were analyzed using proteomics,Western blot,and reverse transcription-quantitative PCR(qPCR).We meas-ured the glucose uptake,L-lactic acid content,and cell energy metabolism parameters using 2-NBDG,ELISA,and a Seahorse energy metabol-izer.Results:MCF-7-BOM-luc cells exhibited stronger migration,invasion,and EMT characteristics as well as more pronounced bone meta-stasis capabilities than the MCF-7-luc cells.Proteomic analysis revealed increased S100 calcium-binding protein A(S100A4)expression in MCF-7-BOM-luc cells,with other differentially expressed proteins being primarily involved in metabolic pathways.Additionally,MCF-7-BOM-luc cells displayed increased expression of E-box binding homeobox 1/2(zinc finger E-box binding homeobox 1/2,ZEB1/2)and Vimentin and reduced E-cadherin expression.MCF-7-BOM-luc cells also exhibited enhanced glucose uptake,L-lactic acid production,and glycolysis rates as well as increased phosphorylation levels of extracellular signal-regulated kinases 1/2(ERK1/2)and signal transducer and activator of tran-scription 3(STAT3).Conclusions:MCF-7-BOM-luc cells promote S100A4 expression through ERK1/2 and STAT3 signaling pathway activation,which in turn enhances the EMT process and glycolysis rate,thereby contributing to malignant bone metastasis.Proteomic analysis of breast cancer bone metastasis-related protein characteristics could offer potential targets for the diagnosis,prevention,and treatment of breast cancer bone metastasis.

Objective:To develop and test the intelligent model for automatically counting the number of vertebral ossification centers below the end of conus medullaris.Methods:From January 2021 to October 2022, 3 000 ultrasound images of the sacrococcygeal spinal middle sagittal plane were retrospectively selected from Shenzhen Maternal and Child Healthcare Hospital and Zhuhai People′s Hospital. The vertebral ossification center and spinal conus medullaris were artificially fine-marked in 2, 800 images for segmentation training. Yolov8 algorithm was used to build the segmentation model for segmentation training, and the fitting and automatic counting of vertebral ossification centers were carried out by post-processing. In the other 200 planes, the counting was performed by the artificial intelligence (AI) model, attending physician (D1), and junior physician (D2), and the accuracy of their performance were evaluated by a specialist physician. The accuracy and the time spent between D1, D2, and AI were compared.Results:The accuracy of AI model segmentation fitting and counting reached 95.00% (190/200) by the specialist physician evaluation, which was almost equal to 94.50%(189/200) by D1( P=0.823) and higher than that of 88.50% by D2(177/200)( P=0.012). The counting time spent for D1, D2, and AI model were 5.00 (4.25, 6.00)s, 7.00 (7.00, 8.00)s, 0.09 (0.08, 0.10)s, respectively, showing that the time spent by AI model was significantly shorter than that of doctors(all P<0.001). Conclusions:The trained artificial intelligence model can efficiently and accurately complete the vertebral ossification center counting below the end of conus medullaris, equivalent to the level of attending physicians. This study is expected to be further applied in the screening of fetal spina bifida and improve the automation and intelligence level of prenatal ultrasound screening.