AIM:To analyze the characteristics and correlation of phacoemulsification parameters and anterior segment parameters in cataract patients with different blood glucose levels.METHODS:A total of 45 type 2 diabetic cataract patients(45 eyes)treated in our hospital from March 2023 to April 2024 were stratified into two groups based on glycosylated hemoglobin(HbA1c)levels: group A: HbA1c <7%(n=18)and group B: 7%≤HbA1c<8.5%(n=27); a total of 94 age-matched age-related cataract patients(94 eyes)were enrolled as the control group(group C). All underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters, including corneal, lens and anterior chamber measurements, were recorded. Correlations between phacoemulsification parameters and anterior segment parameters were analyzed, and differences among groups were compared.RESULTS: In groups A and B, effective phacoemulsification time(EPT)negatively correlated with corneal endothelial cell density(CECD)(r=-0.315, P=0.035). Average phacoemulsification time(APT)positively correlated with the anterior corneal surface radius of curvature(Rm; r=0.402, P=0.006)and negatively correlated with the flat axis meridian curvature(K1), steep axis meridian curvature(K2), mean curvature(Km)of the anterior corneal surface, and lens density at 6 mm zones(PDZ3; all P<0.05). Average phacoemulsification energy(AVE)positively correlated with mean lens density(LD-mean), lens density at 2 mm zones(PDZ1), lens density at 4 mm zones(PDZ2), and PDZ3(all P<0.05), and negatively with pupil diameter(r=-0.385, P=0.009). In the group C, EPT showed a positive correlation with Pentacam nucleus staging(PNS)density grade, PDZ1, PDZ2, and PDZ3(all P<0.05). A positive correlation was observed between AVE and PNS classification(r=0.246, P=0.018). Conversely, AVE exhibited a negative correlation with CECD(r=-0.245, P=0.018). EPT in groups A and B was higher than that in the group C(P<0.05). Both EPT and APT in the group B were higher than those in the group A(P<0.05). In diabetic cataract patients, CECD, corneal density(CD), and posterior corneal surface height positively correlated with diabetes duration(P<0.05). Posterior corneal surface K1 and Rm positively correlated with 7%≤HbA1c<8.5%(P<0.05). Total corneal astigmatism negatively correlated with HbA1c, 2-hour post-breakfast blood glucose(2hPBG), and fasting insulin(FINS; P<0.05). CD and lens thickness(LT)positively correlated with FINS(P<0.05).CONCLUSION: Phacoemulsification parameters and blood glucose-related indices exhibited varying degrees of correlation with anterior segment parameters in cataract patients with different blood glucose levels. EPT in diabetic cataract patients was higher than that in age-related cataract patients, while EPT and APT in diabetic cataract patients with poor glycemic control were higher than those with good glycemic control.

Objective:To explore the chain mediating role of perceived social support and coping modes between perceived risk of recurrence and depression in elderly patients with first-episode ischemic stroke.Methods:Convenience sampling was used to select 310 elderly patients with first-episode ischemic stroke in the Department of Neurology of Jiangsu Wutaishan Hospital and Northern Jiangsu People 's Hospital from December 2022 to February 2024 for the study. General Information Questionnaire, Recurrence Risk Perception Scale for Patients with Stroke, Multidimensional Scale of Perceived Social Support, Medical Coping Modes Questionnaire, and Patient Health Questionnaire were used to investigate the patients and to construct and validate the chain mediating model. Results:A total of 310 questionnaires were distributed and 306 valid questionnaires were recovered, with a valid recovery rate of 98.7%. The total scores of perceived risk of recurrence, perceived social support, medical coping modes, and depression in elderly patients with first-episode ischemic stroke were 35.00 (29.00, 39.00), 59.00 (51.00, 67.00), 43.00 (39.00, 47.00), and 3.50 (2.00, 7.00), respectively. Perceived risk of recurrence was positively correlated with perceived social support and confrontation coping mode ( r=0.418, 0.463; P<0.001), and negatively correlated with depression ( r=-0.450, P<0.001). Perceived social support was positively correlated with confrontation coping mode ( r=0.416, P<0.001), and negatively correlated with depression ( r=-0.408, P<0.001). Confrontation coping mode was negatively correlated with depression ( r=-0.472, P<0.001). The mediating test showed that perceived risk of recurrence negatively predicted depression, with a direct effect of -0.245, accounting for 48.70% of the total effect. The mediating effect of perceived social support on perceived risk of recurrence and depression was significant, with an indirect effect of -0.146, accounting for 29.03% of the total effect. The mediating effect of confrontation coping mode on perceived risk of recurrence and depression was significant, with an indirect effect of -0.085, accounting for 16.90% of the total effect. In addition, perceived social support and confrontation coping modes had a significant chain mediating effect in perceived risk of recurrence and depression, with an indirect effect of -0.027, accounting for 5.37% of the total effect. Conclusions:Perceived social support and confrontation coping mode have chain mediating effects between perceived risk of recurrence and depression. Healthcare professionals can reduce the incidence of depression by increasing the patient 's perceived risk of recurrence, giving a great deal of social support, and enhancing positive modes of coping with the disease.

Objective:To explore the trajectory and influencing factors of oral frailty in first-onset elderly patients with ischemic stroke.Methods:A total of 240 inpatients from the neurology departments of Wutaishan Hospital and Northern Jiangsu People's Hospital between October 2022 and February 2024 were selected by convenience sampling. Oral frailty scores were assessed dynamically at four time points: 1 day before discharge (T 1) , 1 month after discharge (T 2) , 3 months after discharge (T 3) , and 6 months after discharge (T 4) . Latent growth modeling was used to identify potential trajectory categories and analyze their influencing factors. Results:A total of 240 questionnaires were distributed, with 220 valid responses, yielding a response rate of 91.67%. A total of three trajectory types of oral frailty were identified: non-oral frailty group ( n=92) , low-decline group ( n=66) , and high-decline group ( n=62) . Age, marital status, smoking history, dysphagia, National Institute of Health Stroke Scale score, oral health, nutritional status, oral health-related self-efficacy, monthly per capita household income, polypharmacy, denture use, and cognitive function were influencing factors of oral frailty in first-onset elderly patients with ischemic stroke ( P<0.05) . Conclusions:From 1 day before discharge to 6 months after discharge, there are 3 distinct oral frailty trajectories in first-onset elderly patients with ischemic stroke. Medical staff should implement individualized interventions based on the identified influencing factors.

Objective:To explore the chain mediating role of perceived social support and coping modes between perceived risk of recurrence and depression in elderly patients with first-episode ischemic stroke.Methods:Convenience sampling was used to select 310 elderly patients with first-episode ischemic stroke in the Department of Neurology of Jiangsu Wutaishan Hospital and Northern Jiangsu People 's Hospital from December 2022 to February 2024 for the study. General Information Questionnaire, Recurrence Risk Perception Scale for Patients with Stroke, Multidimensional Scale of Perceived Social Support, Medical Coping Modes Questionnaire, and Patient Health Questionnaire were used to investigate the patients and to construct and validate the chain mediating model. Results:A total of 310 questionnaires were distributed and 306 valid questionnaires were recovered, with a valid recovery rate of 98.7%. The total scores of perceived risk of recurrence, perceived social support, medical coping modes, and depression in elderly patients with first-episode ischemic stroke were 35.00 (29.00, 39.00), 59.00 (51.00, 67.00), 43.00 (39.00, 47.00), and 3.50 (2.00, 7.00), respectively. Perceived risk of recurrence was positively correlated with perceived social support and confrontation coping mode ( r=0.418, 0.463; P<0.001), and negatively correlated with depression ( r=-0.450, P<0.001). Perceived social support was positively correlated with confrontation coping mode ( r=0.416, P<0.001), and negatively correlated with depression ( r=-0.408, P<0.001). Confrontation coping mode was negatively correlated with depression ( r=-0.472, P<0.001). The mediating test showed that perceived risk of recurrence negatively predicted depression, with a direct effect of -0.245, accounting for 48.70% of the total effect. The mediating effect of perceived social support on perceived risk of recurrence and depression was significant, with an indirect effect of -0.146, accounting for 29.03% of the total effect. The mediating effect of confrontation coping mode on perceived risk of recurrence and depression was significant, with an indirect effect of -0.085, accounting for 16.90% of the total effect. In addition, perceived social support and confrontation coping modes had a significant chain mediating effect in perceived risk of recurrence and depression, with an indirect effect of -0.027, accounting for 5.37% of the total effect. Conclusions:Perceived social support and confrontation coping mode have chain mediating effects between perceived risk of recurrence and depression. Healthcare professionals can reduce the incidence of depression by increasing the patient 's perceived risk of recurrence, giving a great deal of social support, and enhancing positive modes of coping with the disease.

Objective:To explore the trajectory and influencing factors of oral frailty in first-onset elderly patients with ischemic stroke.Methods:A total of 240 inpatients from the neurology departments of Wutaishan Hospital and Northern Jiangsu People's Hospital between October 2022 and February 2024 were selected by convenience sampling. Oral frailty scores were assessed dynamically at four time points: 1 day before discharge (T 1) , 1 month after discharge (T 2) , 3 months after discharge (T 3) , and 6 months after discharge (T 4) . Latent growth modeling was used to identify potential trajectory categories and analyze their influencing factors. Results:A total of 240 questionnaires were distributed, with 220 valid responses, yielding a response rate of 91.67%. A total of three trajectory types of oral frailty were identified: non-oral frailty group ( n=92) , low-decline group ( n=66) , and high-decline group ( n=62) . Age, marital status, smoking history, dysphagia, National Institute of Health Stroke Scale score, oral health, nutritional status, oral health-related self-efficacy, monthly per capita household income, polypharmacy, denture use, and cognitive function were influencing factors of oral frailty in first-onset elderly patients with ischemic stroke ( P<0.05) . Conclusions:From 1 day before discharge to 6 months after discharge, there are 3 distinct oral frailty trajectories in first-onset elderly patients with ischemic stroke. Medical staff should implement individualized interventions based on the identified influencing factors.

Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

This article reports a patient with extensive high-pressure injection injury of the hand combined with deep chemical burn caused by high-pressure injection of industrial cement materials was diagnosed and treated in the Department of Hand Surgery, Xiaolan Hospital Affiliated to Southern Medical University in 2022. The nerves, tendons and blood vessels of the left hand were involved, and the ulnar skin of the left thumb was extensively necrosis, and a large number of extensive cement foreign bodies remained under the skin. Part of the cement was inserted into the joint capsule of the interphalangeal joint. After emergency surgical treatment, the patient was saved successfully, and the wound healed well without chemical poisoning and other related complications, which created conditions for the second stage of flap repair.

This article reports a patient with extensive high-pressure injection injury of the hand combined with deep chemical burn caused by high-pressure injection of industrial cement materials was diagnosed and treated in the Department of Hand Surgery, Xiaolan Hospital Affiliated to Southern Medical University in 2022. The nerves, tendons and blood vessels of the left hand were involved, and the ulnar skin of the left thumb was extensively necrosis, and a large number of extensive cement foreign bodies remained under the skin. Part of the cement was inserted into the joint capsule of the interphalangeal joint. After emergency surgical treatment, the patient was saved successfully, and the wound healed well without chemical poisoning and other related complications, which created conditions for the second stage of flap repair.

Sutureless technique is a recently developed operation as a first-line therapeutic options for total anomalous pulmonary venous connection (TAPVC). It was originally used to relieve postoperative pulmonary venous obstruction after TAPVC repair and shared a favorable safety and efficacy. Sutureless technique has advantage over conventional repair since the sutures will not touch the intima of pulmonary veins, leading to limited intimal hyperplasia and anastomotic stenosis. In recent years, the sutureless technique has been adopted as a prophylactic method to reduce postoperative obstruction. Compared with the conventional surgery, the indications of the sutureless technique are yet unclear, and a variety of improved methods of sutureless technique with satisfactory outcomes have emerged. This paper review the development of the sutureless technique, introduce some improvements of the surgical technique and summarize indications of suturelss technique.