AIM: To explore the clinical efficacy of 25G minimally invasive vitrectomy combined with 41G ultra-micro subretinal injection of tissue plasminogen activator(t-PA)in the treatment of subretinal hemorrhage(SMH).METHODS: Retrospective study. A totally 60 patients(60 eyes)who visited the Ophthalmology Department of Yuebei People's Hospital from June 2022 to September 2024 and were diagnosed with submacular hemorrhage were selected. According to different treatment methods, they were divided into a control group of 30 eyes(25G vitrectomy combined with intravitreal injection of t-PA)and an observation group of 30 eyes(25G vitrectomy combined with 41G subretinal injection of t-PA). The complete clearance rate of macular hemorrhage, best corrected visual acuity(BCVA), changes in intraocular pressure, central retinal thickness(CRT), the occurrence of postoperative complications were observed in the two groups of patients.RESULTS:The two groups of general data are comparable. After treatment for 7 d, the rate of complete clearance of macular hemorrhage was higher in the observation group than in the control group(100% vs 80%, P<0.05). There was no significant difference between the two groups in the comparison of BCVA at 1 d and 6 mo postoperatively(all P>0.05), and in the comparison of BCVA between the two groups at 7 d, 1, and 3 mo postoperatively, BCVA of the observation group was better than that of the control group(all P<0.05); and the intraocular pressure of the observation group was lower than that of the control group at 1 d, 7 d, and 1 mo postoperatively(all P<0.05), and there was no significant difference between the two groups in the comparison of intraocular pressure at 3 and 6 mo postoperatively(all P>0.05). There was no significant difference between the two groups in the comparison of CRT at 1 d and 6 mo postoperatively(all P>0.05), and CRT was lower than that of the control group at 7 d, 1 and 3 mo postoperatively(all P<0.05). The total incidence of complications in the observation group was not statistically different from that in the control group(0 vs 10%, P>0.05).CONCLUSION: The 25G minimally invasive vitrectomy combined with 41G ultra-microsubretinal injection of t-PA is more efficient in removing subretinal hemorrhage, promotes early anatomical restoration, and has a comparable long-term visual prognosis to the conventional method, with a favorable safety profile.

AIM:To investigate the inhibitory ef-fect of Zushima ointment on inflammation and bone destruction in CIA mice.METHODS:SPF grade male DBA/1 mice were used,6 were random-ly selected as the normal group,and 18 CIA mice that were successfully modelled were randomly di-vided into the model group,the plaster group(1.0 g/kg),and the fuselage group(0.12 g per time)ac-cording to the random number table method,6 mice in each group,and each administered group was given medication according to the body mass,and saline was given to both the normal and model groups.The normal group and the model group were given saline,and breathable adhesive paper was applied once a day for 4 h/session for 4 consec-utive weeks.The arthritis scoring index was used to observe the changes of arthritis symptoms and ar-thritis index scores of mice in each group.Micro-CT was used to observe the damage of hind paw of mice,real-time fluorescence PCR was used to de-tect the mRNA expression of IL-17,IL-1β and TNF-αin ankle joint tissues,and immunohistochemistry was used to detect the expression of OPG and RANKL proteins in ankle joint tissues,and hematox-ylin-eosin(HE)staining was used to observe the pathological changes of synovial tissues after the treatment.The pathological changes of synovial tis-sue were observed after hematoxylin-eosin(HE)staining,and the changes of osteoclasts in ankle joint tissue were observed by anti-tartaric acid phosphatase(TRAP)method.RESULTS:Compared with the normal group,the arthritis index score of the model mice was significantly higher(P＜0.05).Micro-CT showed severe bone erosion in the hind paws of the mice,destruction of the bone surface and reduction of bone volume.The expression of IL-17,IL-1β and TNF-α mRNA(PCR)in the ankle joint tissues was significantly higher(P＜0.05).Im-munohistochemistry showed that the relative ex-pression of OPG protein in the ankle joint tissues was reduced(P＜0.05).Immunohistochemistry showed a decrease in the relative expression of OPG protein(P＜0.01)and an increase in the rela-tive expression of RANKL protein(P＜0.01).HE re-sults showed moderate inflammatory cell infiltra-tion,swelling of synovial cells,massive formation of vascular opacities and synovial hyperplasia;an increase in the number of osteoclasts,roughness of the surface of articular cartilage tissue,severe bone destruction and thinning of the cartilage lay-er.Compared with the model group,the arthritic symptoms of mice in the cream group and the futa-lin group were relieved and the arthritis index score was reduced;the bone density of the mice's hind paws improved,effectively relieving osteopo-rosis;the expression of IL-17,IL-1β and TNF-αmRNA(PCR)in the ankle joint tissue was signifi-cantly reduced(P＜0.05);the immunohistochemical results showed that the relative expression of OPG protein was increased(P＜0.05),the relative expres-sion of RANKL protein decreased(P＜0.01).HE re-sults showed that synovial cell enlargement was significantly improved,mild inflammatory cell infil-tration,synovial hyperplasia was not obvious;the number of broken bone was reduced,articular car-tilage destruction was significantly improved and relieved,and the thickness of cartilage layer was significantly increased.CONCLUSION:Ancestral hemp poultice relieves local symptoms of RA,re-duces the expression of inflammatory factors and attenuates the inflammatory response,possibly by inhibiting osteoclast differentiation and activation through modulation of the OPG/RANKL signalling axis,which further ameliorates the biological ef-fects of articular bone and cartilage destruction.

Rheumatoid arthritis(RA)is an autoimmune disease with the basic pathological manifestation of synovial inflammation.Symmetric poly-articular pain and swelling are the main symptoms in clinical practice,and even extra-articular manifestations and comorbidities such as interstitial fibrosis and coronary artery disease are triggered,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)has achieved good clinical efficacy in the prevention and treatment of RA with the advantages of multi-pathway,multi-target,multi-component,and less toxic side effects,and plays an important role in the treatment of RA.Recently,many studies have demonstrated that Chinese medicine monomers and Chinese herbal compound can control inflammation,reduce angiogenesis,induce apoptosis of synovial fibroblasts,and inhibit their proliferation,invasion and migration by regulating the PI3K/Akt signaling pathway,so as to play a key role in the treatment of RA.For this reason,the article summarizes current knowledge regarding the PI3K/Akt signaling pathway and its role in RA,as well as summarizes the current research progress of TCM in the treatment of RA by regulating the PI3K/Akt signaling pathway.The aim of this review is to provide theoretical bases for the prevention and treatment of RA and the development of new drugs.

Objective To explore EEG characteristics and the therapeutic effect in children with electrical status epilepticus during slow sleep(ESES).Methods The eligible ESES cases in our center from 2014 to 2020 were included.The age at diagnosis of ESES,the duration of ESES,spike wave index(SWI)during wakefulness and the distribution of spike wave during the period of ESES,age at seizure onset,the clinical syndromes and the outcomes after treatment were analyzed.The ESES cases were divided into 4 groups according to the distribution of spike wave:focal ESES,unilateral ESES,bilateral asymmetric ESES,multiple foci ESES.The SWI during the awake stage were divided into 3 groups based on the different rates:≤20%,21%～49%,≥50%.The therapeutic outcomes were classified into three groups:satisfactory response,seizure control and ineffective.Results 50 cases were included,with 32 males and 18 females.The average onset age of ESES was 6 years and 7 months,and the average duration of ESES was 28 months.A significant correlation between the distribution of ESES and the thera-peutic effects was found,bilateral asymmetric ESES had a good therapeutic effects,while multiple foci ESES showed a poor therapeutic effects.The duration of ESES was significantly correlated with therapeutic effects,and the efficacy was worse when the duration was longer than 1 year.A significant relationship between the SWI during wakefulness of ESES and the therapeutic effects was detected,the patient with SWI≤20%during wakefulness had a good therapeutic effect.There was a negative correlation between the onset age of ESES and the duration of ESES and SWI index during wakefulness.There was a positive correlation between the duration of ESES and SWI index during wakefulness.Conclusion Our results suggest that onset age,distribution,duration and SWI during wake-fulness of ESES were correlated with therapeutic outcomes,The patient with SWI≤20%during wakefulness had a good therapeutic effect and have unfavorable outcomes with ESES last more than 1 year.The earlier onset of ESES,the longer duration of ESES and higher SWI during wakefulness will be showed..

Ankylosing spondylitis(AS)is a typical spinal arthritis characterised by inflammatory back pain,which seriously affects the health and quality of life of patients.The clinical efficacy of Chinese medicine in the treatment of ankylosing spondylitis is clear,but the mechanism is not clear,and the existing animal models cannot be well applied to the evaluation of Chinese medicine in the treatment of ankylosing spondylitis.Therefore,this paper summarizes the existing animal models based on Chinese and Western medicine clinical diagnosis,disease characteristics,etiology and Chinese medicine evidence,and finds that among the existing animal models,the proteoglycan-induced arthritis mouse model has a higher Chinese and Western medicine clinical fit than the other models,but lacks the corresponding Chinese medicine evidence model evaluation.The other animal models had a higher Western clinical match,but lacked the characteristics of the Traditional Chinee Medicine(TCM)syndrome.As ankylosing spondylitis is a chronic inflammatory autoimmune disease with complex pathogenic factors,the existing animal models cannot better simulate the clinical symptoms.Therefore,the establishment of animal models of ankylosing spondylitis with the characteristics of Chinese and Western clinical evidence is a future research priority for AS TCM.

Objective:To investigate the physical and mental experience, treatment compliance and use barriers of patients with insomnia in using digital cognitive behavioral therapy for insomnia (dCBT-I) in order to provide qualitative evidence for the development and application optimization of the dCBT-I technology paradigm.Methods:From July to November 2021, a semi-structured interview outline was used to conduct in-depth interviews with the dCBT-I users ( n=10) to record their original feelings about the use of dCBT-I. Interpretative phenomenology's text analysis was used to explore the participants' experience and cognition of dCBT-I. Results:Text analysis and key information calibration were carried out on the verbatim transcripts of semi-structured interview recordings, and three core themes were extracted, namely stickiness factor, use barrier and optimization direction, as well as eight sub-themes, namely professionalism, accessibility, benefit experience, difficulty in task execution, instruction generalization, difficulty in software operation, enrich treatment content and personalized guidance.Conclusion:The present study showed that participants were receptive to the dCBT-I intervention and would be benefited from it.However, dCBT-I still needs to be optimized and improved to reduce the operating difficulty and explore more appropriate timing of manual intervention.

Objective To observe the effect of group biofeedback in patients with residual schiz-ophrenia(RS).Methods A total of 127 patients with RS were selected as study objects,and ran-domly divided into control group(n=63)and observation group(n=64).The control group re-ceived routine nursing,and the observation group received group biofeedback based on the control group.The Positive and Negative Symptom Scale(PANSS),Personal and Social Performance Scale(PSP)and Self-awareness Inventory(SAI)Questionnaire(treatment compliance)scores were com-pared between the two groups.Results After 12 weeks of intervention,the score of the positive symptoms,the score of negative symptoms and the total score of PANSS in the observation group were significantly lower than those in the control group(P＜0.05).The number of patients with PSP scores greater than 70 to 100 and greater than 30 to 70 in the observation group was significantly more than those in the control group,and the number of patients with PSP score of 0 to 30 was significantly less than that in the control group(P＜0.05).The SAI score of the observation group after interven-tion was significantly higher than that before intervention and control group,and the number of com-pleted biofeedback therapy in the observation group was significantly more than that in the control group(P＜0.05).Conclusion Group biofeedback can promote symptom relief and improve treat-ment compliance in patients with RS.

Objective: To investigate the mechanism of resveratrol promoting fibronectin type Ⅲ domain-containing 5 (FNDC5) degradation in skeletal muscle of male obese mice． Methods: Six-week-old male C57BL /6 mice were randomly divided into three groups : standard control diet ( SCD) ，high-fat diet ( HFD) and high-fat diet treated with resveratrol (HFD + RES) ．HFD + RES group was intervened with resveratrol via gavage ［400 mg / kg · d) ］ while fed HFD for 20 weeks．The body mass，serum TG，TC，LDL-C and HDL-C levels were detected．The pathological changes in skeletal muscle were detected by HE staining．The expression of FNDC5，SIRT1，SIRT2，LC3， p62，Beclin-1，ATG5，ATG7 was assessed by immunohistochemistry，RT-PCR and Western blot respectively. Results: The body mass ，serum TG ，TC and LDL-C levels increased significantly ，meanwhile HDL-C levels decreased in HFD group．Lipid deposition between skeletal muscle fibers were obvious in HFD group．The immuno- histochemistry results showed that protein expression levels of SIRT1，SIRT2 and LC3 obviously decreased，while the protein levels of FNDC5 and p62 obviously increased．The expression levels of FNDC5 significantly increased， while the gene expression levels of SIRT1，SIRT2，LC3，Atg7 and Beclin-1 obviously decreased．All these responses were attenuated by treatment with RES． Conclusion RES has obvious effects of lipid-lowering and promoting FNDC5 degradation in skeletal muscle tissues，which may be related with SIRT1 and SIRT2-induced autophagy， thus resulting in degradation of FNDC5 .

Objective: To investigate the oxidative stress injury of nano zinc oxide nanoparticles(ZnO NPs) on human myocardial cells (AC16) ，and to analyze the mechanism of ZnO NPs from the transcriptome level． Methods: Dynamic light scattering (DLS) was used to characterize and detect ZnO NPs．After AC16 cells were exposed to ZnO NPs at different doses and at different times，the cell survival rate was determined by CCK-8 method．AC16 cells were divided into control group，ZnO NPs (50，100，200 μmol /L) ，after 6 h treatment，the mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) were measured．AC16 cells were divided into control group，50 μmol /L ZnO NPs group and 200 μmol /L ZnO NPs group．After 6 h exposure，total RNA was extracted by TRIzol for transcriptome analysis ，and the differentially expressed genes were enriched by gene body ( GO) ，Kyoto Encyclopedia of Genes and Genomes (KEGG) . Results : The results of DLS showed that the hydrodynamic diameter was ( 192. 2 ± 1. 63 ) nm and the Zeta potential was ( －23. 26 ± 1. 05 ) mV． CCK-8 results showed that the survival rate of AC16 cells decreased with the increase of dose and time of exposure to ZnO NPs. Fluorescence quantification showed that with the increase of ZnO NPs exposure dose，MMP significantly decreased at 100 μmol /L ZnO NPs(P＜0. 05) ，and ROS significantly increased at 50 μmol /L ZnO NPs(P＜0. 05) ．Using the multifunctional microplate reader，it was observed that MMP and ROS were statistically significant at 100 and 50 μmol /L ZnO NPs，respectively，showing a decrease in MMP and an increase in ROS．Transcriptome analysis showed that 1 071 genes were enriched in the 50 μmol /L ZnO NPs group compared with the control group，including 561 up-regulated genes and 510 down-regulated genes．Compared with the control group，7 164 genes were enriched in 200 μmol /L ZnO NPs group，including 4 098 up-regulated genes and 3 066 down-regulated genes．GO and KEGG analysis showed that the differential genes were mainly concentrated in ROS，antioxidant activity，mitochondrial cytochrome C release，apoptosis and other signaling pathways． Conclusion ZnO NPs can decrease the survival rate of AC16 cells and induce mitochondrial damage and oxidative stress，among which ROS-mediated oxi- dative stress and mitochondrial function changes are important toxic mechanisms of ZnO NPs induced AC16 cytotoxicity.

Objective To observe the effect of group biofeedback in patients with residual schiz-ophrenia(RS).Methods A total of 127 patients with RS were selected as study objects,and ran-domly divided into control group(n=63)and observation group(n=64).The control group re-ceived routine nursing,and the observation group received group biofeedback based on the control group.The Positive and Negative Symptom Scale(PANSS),Personal and Social Performance Scale(PSP)and Self-awareness Inventory(SAI)Questionnaire(treatment compliance)scores were com-pared between the two groups.Results After 12 weeks of intervention,the score of the positive symptoms,the score of negative symptoms and the total score of PANSS in the observation group were significantly lower than those in the control group(P＜0.05).The number of patients with PSP scores greater than 70 to 100 and greater than 30 to 70 in the observation group was significantly more than those in the control group,and the number of patients with PSP score of 0 to 30 was significantly less than that in the control group(P＜0.05).The SAI score of the observation group after interven-tion was significantly higher than that before intervention and control group,and the number of com-pleted biofeedback therapy in the observation group was significantly more than that in the control group(P＜0.05).Conclusion Group biofeedback can promote symptom relief and improve treat-ment compliance in patients with RS.