In recent years, with the endless emergence of meibomian gland dysfunction(MGD)diagnostic equipment, rich treatment methods, and in-depth clinical and basic research on MGD at home and abroad, the understanding of MGD has entered a new stage. MGD-related dry eye is considered to be the main cause of lipid abnormal dry eye, and its occurrence and development is a chronic and multi-factorial pathological process. This article reviews the pathogenesis, imaging analysis and clinical treatment progress of MGD-related dry eye, in order to provide scientific evidence and ideas for clinical diagnosis and therapy of MGD-related dry eye.

Objective:To investigate the risk factors of vascular complications (VC) after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.Methods:A total of 80 patients with aortic stenosis admitted to the Affiliated Hospital of Jining Medical University from January 2018 to June 2023 were retrospectively included as the study objects. All patients underwent TAVI surgery and were divided into VC group (13 cases, 16.3%) and N-VC group (67 cases, 83.7%) according to whether VC occurred after TAVI surgery. The preoperative basic characteristics, surgery-related indexes and preoperative laboratory indexes were compared between the two groups. Multivariate logistic regression analysis was used to screen out independent predictors of postoperative VC in patients with aortic stenosis after TAVI. Based on independent predictors, a nomogram model was constructed, and the calibration curve of the nomogram model was drawn for internal verification. Receiver operating characteristic (ROC) curves were drawn to predict VC after TAVI in patients with aortic stenosis, and the predictive efficacy of the combined prediction model was further analyzed.Results:The proportion of female patients, the proportion of diabetic patients, the mean cross-valve pressure difference, the proportion of vascular wall calcification, the proportion of transapical surgical routes, brain natriuretic peptide (BNP) and creatinine in VC group were significantly higher than those in the N-VC group, and the left ventricular ejection fraction was significantly lower than that in the N-VC group, with statistical significance (all P<0.05). Multivariate logistic regression analysis showed that gender, combined diabetes, surgical path and BNP were independent risk factors of postoperative VC in patients with TAVI (all P<0.05). Based on four independent risk factors, a nomogram model was constructed to predict the occurrence of VC after TAVI in patients with aortic stenosis. The calibration curve showed that the predicted value of VC after TAVI in patients with aortic stenosis was in good agreement with the actual observed value ( P>0.05). ROC curve analysis results showed that the area under the curve (AUC) of gender, combined diabetes, surgical path and BNP in predicting the occurrence of VC after TAVI in aortic stenosis patients were 0.745, 0.769, 0.834 and 0.857, respectively, and the AUC of the combined prediction was 0.938. Conclusions:Gender, age, surgical path and BNP are independent predictors of VC after TAVI in patients with aortic stenosis. The nomogram model based on independent predictors has high predictive value.

OBJECTIVE To investigate the deglycosylation metabolism of dioscin in vivo and the changes of its anti-tumor activi-ty of its deglycosylated metabolites.METHODS An LC-MS/MS analysis method for simultaneous determination of dioscin and its deglycosylation metabolites was established to study the cumulative excretion amount of dioscin and its deglycosylated metabolites in rat feces after oral administration.To mimic its deglycosylation metabolism,HPLC method was applied to investigate the time-dependent changes in the prototype components and metabolites of dioscin after incubation in artificial gastric juice.Solid-phase extraction tech-nology was employed to isolate the product of dioscin following hydrolysis by artificial gastric juice.The cytotoxic effects of this product on human colon cancer cells HCT-116 were assessed using the CCK-8 assay across different hydrolysis time periods.Concurrently,the enzymatic activities of caspase-3 and caspase-9,along with the expression levels of cytochrome C,were measured to elucidate the impact of dioscin post-hydrolysis on the cytotoxicity against HCT-116 cells.RESULTS Dioscin and its series of deglycosylated me-tabolites were detected in rat feces,revealing no significant differences in the cumulative excretion amounts of Polyphyllin Ⅴ and Pro-genin Ⅱ.Dioscin was shown to generate a range of deglycosylated metabolites in artificial gastric juice.Furthermore,dioscin and its deglycosylated metabolites inhibited the proliferation of HCT-116 cells,induced morphological changes,and increased the enzymatic activities of caspase-3 and caspase-9,as well as cytochrome C expression.However,it was observed that the antitumor activity of the deglycosylated metabolites diminished with prolonged hydrolysis time.CONCLUSION The deglycosylation metabolism of dioscin sig-nificantly attenuates its inhibitory effect on the proliferation of HCT-116 cells.Suppressing the acid-mediated or gut microbiota-medi-ated deglycosylation metabolism may be a promising strategy to preserve its antitumor activity.

OBJECTIVE To investigate the deglycosylation metabolism of dioscin in vivo and the changes of its anti-tumor activi-ty of its deglycosylated metabolites.METHODS An LC-MS/MS analysis method for simultaneous determination of dioscin and its deglycosylation metabolites was established to study the cumulative excretion amount of dioscin and its deglycosylated metabolites in rat feces after oral administration.To mimic its deglycosylation metabolism,HPLC method was applied to investigate the time-dependent changes in the prototype components and metabolites of dioscin after incubation in artificial gastric juice.Solid-phase extraction tech-nology was employed to isolate the product of dioscin following hydrolysis by artificial gastric juice.The cytotoxic effects of this product on human colon cancer cells HCT-116 were assessed using the CCK-8 assay across different hydrolysis time periods.Concurrently,the enzymatic activities of caspase-3 and caspase-9,along with the expression levels of cytochrome C,were measured to elucidate the impact of dioscin post-hydrolysis on the cytotoxicity against HCT-116 cells.RESULTS Dioscin and its series of deglycosylated me-tabolites were detected in rat feces,revealing no significant differences in the cumulative excretion amounts of Polyphyllin Ⅴ and Pro-genin Ⅱ.Dioscin was shown to generate a range of deglycosylated metabolites in artificial gastric juice.Furthermore,dioscin and its deglycosylated metabolites inhibited the proliferation of HCT-116 cells,induced morphological changes,and increased the enzymatic activities of caspase-3 and caspase-9,as well as cytochrome C expression.However,it was observed that the antitumor activity of the deglycosylated metabolites diminished with prolonged hydrolysis time.CONCLUSION The deglycosylation metabolism of dioscin sig-nificantly attenuates its inhibitory effect on the proliferation of HCT-116 cells.Suppressing the acid-mediated or gut microbiota-medi-ated deglycosylation metabolism may be a promising strategy to preserve its antitumor activity.

Objective:To investigate the risk factors of vascular complications (VC) after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.Methods:A total of 80 patients with aortic stenosis admitted to the Affiliated Hospital of Jining Medical University from January 2018 to June 2023 were retrospectively included as the study objects. All patients underwent TAVI surgery and were divided into VC group (13 cases, 16.3%) and N-VC group (67 cases, 83.7%) according to whether VC occurred after TAVI surgery. The preoperative basic characteristics, surgery-related indexes and preoperative laboratory indexes were compared between the two groups. Multivariate logistic regression analysis was used to screen out independent predictors of postoperative VC in patients with aortic stenosis after TAVI. Based on independent predictors, a nomogram model was constructed, and the calibration curve of the nomogram model was drawn for internal verification. Receiver operating characteristic (ROC) curves were drawn to predict VC after TAVI in patients with aortic stenosis, and the predictive efficacy of the combined prediction model was further analyzed.Results:The proportion of female patients, the proportion of diabetic patients, the mean cross-valve pressure difference, the proportion of vascular wall calcification, the proportion of transapical surgical routes, brain natriuretic peptide (BNP) and creatinine in VC group were significantly higher than those in the N-VC group, and the left ventricular ejection fraction was significantly lower than that in the N-VC group, with statistical significance (all P<0.05). Multivariate logistic regression analysis showed that gender, combined diabetes, surgical path and BNP were independent risk factors of postoperative VC in patients with TAVI (all P<0.05). Based on four independent risk factors, a nomogram model was constructed to predict the occurrence of VC after TAVI in patients with aortic stenosis. The calibration curve showed that the predicted value of VC after TAVI in patients with aortic stenosis was in good agreement with the actual observed value ( P>0.05). ROC curve analysis results showed that the area under the curve (AUC) of gender, combined diabetes, surgical path and BNP in predicting the occurrence of VC after TAVI in aortic stenosis patients were 0.745, 0.769, 0.834 and 0.857, respectively, and the AUC of the combined prediction was 0.938. Conclusions:Gender, age, surgical path and BNP are independent predictors of VC after TAVI in patients with aortic stenosis. The nomogram model based on independent predictors has high predictive value.

Objectives:To evaluate the clinical outcome of acute respiratory distress syndrome (ARDS) in patients with Stanford Type A aortic dissection (AAD).Methods:A total of 212 patients diagnosed with AAD and receiving surgical treatment in the Affiliated Hospital of Jining Medical University from January 2016 to December 2021 were included. The patients were divided into ARDS group and non-ARDS group based on the definition of ARDS Berlin after surgery. The preoperative general clinical data of the two groups were compared by univariate analysis, and the preference-matching variables were screened. The patients were divided into ARDS group ( n=63) and non-ARDS group ( n=63) by using propensity matching score, and the clinical outcome indexes of ARDS group and non-ARDS group were compared after matching. Results:A total of 63 patients (29.7%) were diagnosed with ARDS after AAD. A total of 63 pairs of patients were successfully matched using propensity score to adjust preoperative confounding factors. After matching, the proportion of total arch surgery, operation time, perioperative blood loss, red blood cell transfusion and plasma transfusion in the ARDS group were significantly higher than those in the non-ARDS group, with statistical significance (all P<0.05). After the match, In the ARDS group, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score [18(14-24)points vs 13(12-15)points], mechanical ventilation time [86.0(57.3-158.0)h vs 41.5(23.8-60.4)h], intensive care unit (ICU) stay time [7.0(6.0-11.5)d vs 4.0(3.0-6.0)d] and hospital stay [18.0(14.0-24.5)d vs 13.5(10.8-18.0)d] were significantly higher than those in the non-ARDS group, with statistical significance (all P<0.05). There was no significant difference in in-hospital mortality (3.2% vs 1.6%) or within 30 days after discharge (6.3% vs 3.2%) between the two groups (all P>0.05). Conclusions:The incidence of ARDS is higher in patients diagnosed with AAD based on the Berlin definition, but there is no increase in the mortality rate within 30 days of hospital and discharge in ARDS group. The Berlin definition of ARDS may have some limitations in the application of ARDS in patients with AAD after surgery.

Purpose: Molecular residual disease (MRD) is a promising biomarker in colorectal cancer (CRC) for prognosis and guiding treatment, while the whole-exome sequencing (WES) based tumor-informed assay is standard for evaluating MRD based on circulating tumor DNA (ctDNA). In this study, we assessed the feasibility of a fixed-panel for evaluating MRD in CRC. Materials and Methods: Seventy-five patients with resectable stage I-III CRC were enrolled. Tumor tissues obtained by surgery, and preoperative and postoperative day 7 blood samples were collected. The ctDNA was evaluated using the tumor-agnostic and tumor-informed fixed assays, as well as the WES-based and panel-based personalized assays in randomly selected patients. Results: The tumor-informed fixed assay had a higher preoperative positive rate than the tumor-agnostic assay (73.3% vs. 57.3%). The preoperative ctDNA status failed to predict disease-free survival (DFS) in either of the fixed assays, while the tumor-informed fixed assay-determined postoperative ctDNA positivity was significantly associated with worse DFS (hazard ratio [HR], 20.74; 95% confidence interval [CI], 7.19 to 59.83; p < 0.001), which was an independent predictor by multivariable analysis (HR, 28.57; 95% CI, 7.10 to 114.9; p < 0.001). Sub-cohort analysis indicated the WES-based personalized assay had the highest preoperative positive rate (95.1%). The two personalized assays and the tumor-informed fixed assay demonstrated same results in postoperative landmark (HR, 26.34; 95% CI, 6.01 to 115.57; p < 0.001), outperforming the tumor-agnostic fixed panel (HR, 3.04; 95% CI, 0.94 to 9.89; p=0.052). Conclusion Our study confirmed the prognostic value of the ctDNA positivity at postoperative day 7 by the tumor-informed fixed panel. The tumor-informed fixed panel may be a cost-effective method to evaluate MRD, which warrants further studies in future.

Diabetic macular edema (DME) is the main cause of vision loss in diabetic patients, its pathogenesis is complicated, and the clinical treatment is not good. DME is extremely harmful to vision. With the deepening of relevant studies, its related pathological mechanism has become more and more clear, and the treatment methods have also changed accordingly. In recent years, the rapid development of intracocular fluid cytokine detection technology has provided a more reasonable explanation of the mechanism of DME and made the choice of treatment more reasonable. However, the acquisition of intraocular fluid is an invasive operation with a certain risk of infection. If the level of relevant cytokines in intraocular fluid can be linked with the relevant imaging indicators, it will provide a better choice for the treatment and prognosis monitoring of DME and reduce the risk of invasive operation, and further clinical studies are needed to explore its correlation in the future.

Objectives:To evaluate the clinical outcome of acute respiratory distress syndrome (ARDS) in patients with Stanford Type A aortic dissection (AAD).Methods:A total of 212 patients diagnosed with AAD and receiving surgical treatment in the Affiliated Hospital of Jining Medical University from January 2016 to December 2021 were included. The patients were divided into ARDS group and non-ARDS group based on the definition of ARDS Berlin after surgery. The preoperative general clinical data of the two groups were compared by univariate analysis, and the preference-matching variables were screened. The patients were divided into ARDS group ( n=63) and non-ARDS group ( n=63) by using propensity matching score, and the clinical outcome indexes of ARDS group and non-ARDS group were compared after matching. Results:A total of 63 patients (29.7%) were diagnosed with ARDS after AAD. A total of 63 pairs of patients were successfully matched using propensity score to adjust preoperative confounding factors. After matching, the proportion of total arch surgery, operation time, perioperative blood loss, red blood cell transfusion and plasma transfusion in the ARDS group were significantly higher than those in the non-ARDS group, with statistical significance (all P<0.05). After the match, In the ARDS group, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score [18(14-24)points vs 13(12-15)points], mechanical ventilation time [86.0(57.3-158.0)h vs 41.5(23.8-60.4)h], intensive care unit (ICU) stay time [7.0(6.0-11.5)d vs 4.0(3.0-6.0)d] and hospital stay [18.0(14.0-24.5)d vs 13.5(10.8-18.0)d] were significantly higher than those in the non-ARDS group, with statistical significance (all P<0.05). There was no significant difference in in-hospital mortality (3.2% vs 1.6%) or within 30 days after discharge (6.3% vs 3.2%) between the two groups (all P>0.05). Conclusions:The incidence of ARDS is higher in patients diagnosed with AAD based on the Berlin definition, but there is no increase in the mortality rate within 30 days of hospital and discharge in ARDS group. The Berlin definition of ARDS may have some limitations in the application of ARDS in patients with AAD after surgery.

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.