High myopia has become a major public health concern worldwide, particularly in China and Southeast Asia. It is associated not only with a variety of fundus diseases but also with earlier onset and greater severity of cataracts, resulting in significant visual impairment. Phacoemulsification is currently the main surgical treatment for cataracts. However, intraoperative fluctuations in perfusion pressure and exposure to ultrasonic energy may affect the vitreoretinal structures, potentially accelerating the progression of fundus pathology after surgery in highly myopic eyes. This article summarizes current evidence on the progression of posterior scleral staphyloma, myopic maculopathy, and retinal detachment following phacoemulsification in highly myopic eyes.

Background and purpose:Limited-stage(LS)-small cell esophageal carcinoma(SCEC),characterized by high aggressiveness and an extremely poor prognosis,lacks standardized staging systems due to its rarity.Consequently,no randomized controlled clinical trials exist to guide therapeutic strategies,necessitating reliance on extrapolated protocols from small cell lung cancer(SCLC)paradigms,though clinical outcomes remain dismal.This study aimed to analyse survival outcomes,prognostic factors,failure patterns and therapeutic strategies in patients with LS-SCEC.Methods:We conducted a retrospective single-center study of LS-SCEC patients diagnosed and treated at Fudan University Shanghai Cancer Center from January 2006 to June 2023.Clinicopathological data for diagnosis,staging and follow-up were rigorously collected.Patients with mixed esophageal tumors in whom small cell carcinoma was not the predominant histological component(＜50%)were excluded.Continuous variables were presented as x±s.Categorical variables were summarized as counts and percentages,with intergroup comparisons performed using χ2 test or Fisher's exact tests.Survival analysis was performed using the Kaplan-Meier method,and Cox regression was used to analyse factors related to prognosis.A two-sided P＜0.050 was considered statistically significant.A 1∶1 nearest-neighbour propensity score matching was applied to compare survival outcomes between patients undergoing radical chemoradiotherapy and those receiving radical surgery followed by adjuvant chemotherapy.Results:Of 261 eligible LS-SCEC patients included,the median follow-up duration was 72.7 months(95%CI:52.0-92.4),with a median cancer-specific survival(CSS)of 24.5 months(95%CI:19.7-29.3)and a 5-year CSS rate of 32.8%.The median progression-free survival(PFS)was 12.0 months(95%CI:10.7-13.3).Among these,67 patients remained recurrence-free,and 169 patients exhibited disease progression after first-line treatment.Distant metastasis was the predominant recurrence pattern(131 patients,77.5%),whereas locoregional recurrence occurred in only 38 patients(22.5%).The most frequent metastatic sites were liver(54 patients),followed by bone(25 patients),brain(24 patients),and lung(23 patients).The number of chemotherapy cycle and TNM stage(8th edition)were independent prognostic factors for CSS and PFS in LS-SCEC patients.Comparative analysis of radical surgery with adjuvant chemotherapy versus radical chemoradiotherapy revealed no statistically significant differences in CSS and PFS(P＞0.05),even after propensity score matching.Patients with cervical/upper thoracic tumors,longer tumor lengths,and advanced stages were more likely to receive chemoradiotherapy;additionally,the chemoradiotherapy group had a higher proportion of patients completing≥4 chemotherapy cycle.Conclusion:This large-sample retrospective study with comprehensive datasets and long-term follow-up demonstrated comparable survival outcomes between radical chemoradiotherapy and radical surgery plus adjuvant chemotherapy for LS-SCEC.A minimum of 4 chemotherapy cycle was associated with improved prognosis.SCEC is associated with a high risk of distant metastasis and marked heterogeneity.Therefore,the treatment of LS-SCEC should prioritize an individualized approach.

Objective:To construct an evaluation indicator system for power system of otolaryngology surgery,so as to provide references for the configuration of surgical power devices of medical institutions.Methods:Literature review and brainstorming were used to analyze existing literature related to surgical power.Combined with expert opinions and clinical demands,an evaluation indicator system was initially proposed.The Delphi method was adopted to determine the evaluation indicators of power system of otolaryngology surgery.The analytic hierarchy process(AHP)method was used to determine the evaluation indicator system of the power system of otolaryngology surgery,which were constructed by weight of each indicator.Results:The evaluation indicator system of power system of otolaryngology surgery included 5 first-level indicators(integrity of medical equipment,products'performance indicators,safety,clinical application effect,and after-sales service guarantee)and 49 second-level indicators under the first-level indicators.In the first-level indicators,equipment's safety had the highest weight(20.48%).In the second-level indicators,the top three of the combined weights were respectively integrity of equipment's main device(7.19%),accessory's integrity(7.03%),and identification's integrity(6.03%).Conclusion:The evaluation index system for otolaryngological surgical power systems clarifies the core dimensions,specific indicators and relative importance of the evaluation,and can be applied to the procurement and selection of surgical power devices in medical institutions,performance testing,clinical effect evaluation and other aspects.

One of the significant hurdles in telemedicine, particularly in ophthalmology, is the absence of direct physical examination. This specialty depends extensively on specialized instruments that typically require proficient operators. Visual function tests are crucial for both outpatient and inpatient ophthalmic services, playing a vital role in screening, diagnosing, monitoring treatment effectiveness, and managing follow-ups for various eye conditions. The progress in mobile technology has paved the way for expanding these tests beyond traditional clinic settings, promoting the creation of patient-focused, straightforward, cost-effective, and efficient measurement tools. In light of the swift advancement of digital technologies, this article reviews the characteristics, and reliability of self-administered visual function tests tools, including visual acuity, refractive error assessment, visual field, contrast sensitivity, and color vision, along with other pertinent diagnostic tools that have been developed and validated for accuracy and repeatability through research, with a view to providing ophthalmologists and patients with scientific and practical references when selecting and using these tools, further promoting efficiency and efficacy of teleophthalmology.

This review summarizes the current status, assessment tools, influencing factors, and interventions related to return to work among middle-aged lung cancer patients after surgery. The aim is to provide a reference for future research and the development of intervention programs to support return to work in this population.

Lateral posterior choroidal artery aneurysm is rare.The authors reported a patient diagnosed as lateral posterior choroidal artery aneurysm with intracerebral hemorrhage as the first manifestation,and discussed its pathogenesis,diagnosis and treatment.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

As an emerging concept, digital twin is a digital representation of physical objects. Due to its ability to accurately capture and present the physical world, it has been widely applied in multiple fields. Moreover, it also has good development prospects and potential in the field of nursing. This article reviews the application status of digital twin and its applications in chronic disease nursing, nursing management, clinical teaching, etc., aiming to provide references for the development and application of digital twin in the nursing field. It is expected that digital twin can better support doctors and patients in making clinical decisions in various ways, and achieve patient-centered, precise, and personalized nursing care.

Background and purpose:Limited-stage(LS)-small cell esophageal carcinoma(SCEC),characterized by high aggressiveness and an extremely poor prognosis,lacks standardized staging systems due to its rarity.Consequently,no randomized controlled clinical trials exist to guide therapeutic strategies,necessitating reliance on extrapolated protocols from small cell lung cancer(SCLC)paradigms,though clinical outcomes remain dismal.This study aimed to analyse survival outcomes,prognostic factors,failure patterns and therapeutic strategies in patients with LS-SCEC.Methods:We conducted a retrospective single-center study of LS-SCEC patients diagnosed and treated at Fudan University Shanghai Cancer Center from January 2006 to June 2023.Clinicopathological data for diagnosis,staging and follow-up were rigorously collected.Patients with mixed esophageal tumors in whom small cell carcinoma was not the predominant histological component(＜50%)were excluded.Continuous variables were presented as x±s.Categorical variables were summarized as counts and percentages,with intergroup comparisons performed using χ2 test or Fisher's exact tests.Survival analysis was performed using the Kaplan-Meier method,and Cox regression was used to analyse factors related to prognosis.A two-sided P＜0.050 was considered statistically significant.A 1∶1 nearest-neighbour propensity score matching was applied to compare survival outcomes between patients undergoing radical chemoradiotherapy and those receiving radical surgery followed by adjuvant chemotherapy.Results:Of 261 eligible LS-SCEC patients included,the median follow-up duration was 72.7 months(95%CI:52.0-92.4),with a median cancer-specific survival(CSS)of 24.5 months(95%CI:19.7-29.3)and a 5-year CSS rate of 32.8%.The median progression-free survival(PFS)was 12.0 months(95%CI:10.7-13.3).Among these,67 patients remained recurrence-free,and 169 patients exhibited disease progression after first-line treatment.Distant metastasis was the predominant recurrence pattern(131 patients,77.5%),whereas locoregional recurrence occurred in only 38 patients(22.5%).The most frequent metastatic sites were liver(54 patients),followed by bone(25 patients),brain(24 patients),and lung(23 patients).The number of chemotherapy cycle and TNM stage(8th edition)were independent prognostic factors for CSS and PFS in LS-SCEC patients.Comparative analysis of radical surgery with adjuvant chemotherapy versus radical chemoradiotherapy revealed no statistically significant differences in CSS and PFS(P＞0.05),even after propensity score matching.Patients with cervical/upper thoracic tumors,longer tumor lengths,and advanced stages were more likely to receive chemoradiotherapy;additionally,the chemoradiotherapy group had a higher proportion of patients completing≥4 chemotherapy cycle.Conclusion:This large-sample retrospective study with comprehensive datasets and long-term follow-up demonstrated comparable survival outcomes between radical chemoradiotherapy and radical surgery plus adjuvant chemotherapy for LS-SCEC.A minimum of 4 chemotherapy cycle was associated with improved prognosis.SCEC is associated with a high risk of distant metastasis and marked heterogeneity.Therefore,the treatment of LS-SCEC should prioritize an individualized approach.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.