ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

Objective To analyze the technical essentials of single-microport assisted micro-uni-port thoracoscopic surgery, and to investigate its surgical efficacy and promotional value. Methods Clinical data of patients who consecutively underwent radical upper lobectomy in the Department of Thoracic Surgery of Xi'an International Medical Center Hospital from March 2023 to June 2024 were retrospectively analyzed. According to the surgical approach, patients were divided into two groups: the single-microport assisted group (underwent upper lobectomy via single-microport assisted micro-uni-port thoracoscopy) and the traditional uniportal group (underwent traditional uniportal thoracoscopic lobectomy). Clinical outcomes were compared between the two groups. Results A total of 62 patients were enrolled. There were 30 patients in the single-microport assisted group, with a mean age of (57.4±10.8) years, and 32 patients in the traditional uniportal thoracoscopic group, with a mean age of (57.6±8.7) years. The baseline data were comparable between the two groups. All patients in both groups successfully underwent minimally invasive surgery without conversion to thoracotomy. The operative time in the single-microport assisted group was significantly shorter than that in the traditional uniportal group [(146.03±30.79) min vs. (171.41±36.41) min, P=0.004]. However, there were no statistically significant differences between the two groups in intraoperative blood loss, number of dissected lymph nodes, duration of chest tube drainage, postoperative pain score, postoperative hospital stay, hospitalization cost, or incidence of postoperative complications (all P>0.05). Conclusion Single-microport assisted micro-uni-port thoracoscopic surgery for upper lobectomy can maximally integrate the advantages of three-port and uni-port VATS while effectively avoiding their disadvantages. It significantly shortens the operative time without increasing postoperative pain or complications, and represents a more minimally invasive, safer, and more convenient surgical approach.

Objective To investigate the current status and experience of scientific research,attitude and demand for research training,and other research situations in military doctors with standardized training,to construct a targeted training system for research capacity of military general practitioners,and to explore the effect of the training system on the comprehensive research ability of military doctors.Methods Eighty-one military general practitioners who participated in the standardized training at The First Affiliated Hospital of Naval Medical University in 2022 were selected as research objects.A questionnaire-based survey was conducted among these doctors.SPSS 25.0 software was used to analyze the data obtained.The cultivation of research capacity included the training of basic research skills,advancement of reseach capacity,and the improvement of the assessment and incentive mechanism.Before and one year after the training,the research status,research attitude and demand,comprehensive research capacity,and mentor's evaluation for the research capacity were investigated.Results After one year of training,basic research skills and comprehensive research capacity of military general practitioners were significantly improved,mentor's evaluation was gradually improved,research achievements were significantly increased,training attitudes became more positive,and training needs changed.Conclusion The research capacity of military general practitioners has been significantly improved through the construction of training system of research capacity and continuous practice.

Objective To explore the application value of CT classification of lumbar spinal stenosis(LSS)in selecting endoscopic decompression surgery approach.Methods The clinical data and CT imaging materials of 300 patients with LSS,who received percutaneous endoscopic decompression surgery from March 2018 to December 2024 were selected from Hengshui Municipal People's Hospital in Hebei(Halison International Peace Hospital),were retrospectively analyzed.Preoperative CT scan was performed in all patients.Taking endoscopic classification as the golden standard,the consistency between CT classification results and endoscopic classification results was assessed by Kappa consistency analysis.The effect of surgery of different approaches for percutaneous endoscopic decompression surgery was compared.Results CT diagnostic classification of type Ⅰ LSS was obtained in 87 patients(among them 3 patients with type Ⅲ LSS were misdiagnosed as type Ⅰ LSS),type Ⅱ LSS in 141 patients and type ⅢLSS in 72 patients,the total diagnostic accuracy rate was 97.67％.Using endoscopic classification as the gold standard,the Kappa values for CT diagnosis of type Ⅰ,type Ⅱ and type Ⅲ were 0.975,1.000 and 0.973,respectively.According to the CT classification results,all 300 patients successfully selected different surgical approaches to complete the surgery,and their clinical symptoms were significantly relieved without significant complications.After surgery,the Oswestry disability index(ODI)and visual analogue scale(VAS)scores of leg/lower back in patients with different LSS types showed a decreasing trend(P＜0.05).After treatment,the total frequency of taking non-steroidal drugs was significantly lower than that before surgery(P＜0.05).Conclusion The classification of LSS is highly consistent between CT scan and endoscopic examination,which is of great value for the selection of percutaneous endoscopic decompression surgery approach.

[Purpose]To investigate the potential causal relationships between serum levels of trace elements and head and neck cancers.[Methods]Single nucleotide polymorphism(SNP)of oral cancer,oropharyngeal cancer,laryngeal cancer and thyroid cancer,associated with calcium,copper,iron,magnesium,zinc,were obtained from genome-wide association studies(GWAS).A two-sample bidirectional Mendelian randomization(MR)analysis was performed using the inverse variance weighting(IVW)method by calculating odds ratio(OR)and 95％confidence interval(CI).Pleiotropy was assessed using MR-PRESSO and MR-Egger regression,and sensitivity analysis was conducted via the"leave-one-out"method.[Results]IVW analysis revealed a causal association between serum magnesium levels and the incidence of oral cancer(OR=0.976,95％CI:0.956～0.997,P=0.025),also between thyroid cancer and serum calcium levels(OR=1.008,95％CI:1.001～1.015,P=0.023).No significant causal associations were observed between other trace ele-ments and head and neck cancers(all P＞0.05).[Conclusion]This MR study suggests that serum magnesium levels serve as a protective factor against oral cancer,while thyroid cancer leads to el-evated serum calcium levels.

Objective： The aim of this study is to explore the predictive value of biparametric magnetic resonance imaging(bpMRI)for pelvic lymph node metastasis in prostate cancer patients with PSA≤20 μg/L and establish a nomogram. Methods： The imaging data and clinical data of 363 patients undergoing radical prostatectomy and pelvic lymph node dissection in the First Affiliated Hospital of Nanjing Medical University from July 2018 to December 2023 were retrospectively analyzed. Univariate analysis and multivariate logistic regression were used to screen independent risk factors for pelvic lymph node metastasis in prostate cancer, and a nomogram of the clinical prediction model was established. Calibration curves were drawn to evaluate the accuracy of the model. Results： Multivariate logistic regression analysis showed extrocapusular extension (OR=8.08,95%CI=2.62－24.97, P<0.01), enlargement of pelvic lymph nodes (OR=4.45,95%CI=1.16－17.11,P=0.030), and biopsy ISUP grade(OR=1.97,95%CI=1.12－3.46, P=0.018)were independent risk factors for pelvic lymph node metastasis. The C-index of the prediction model was 0.834, which indicated that the model had a good prediction ability. The actual value of the model calibration curve and the prediction probability of the model fitted well, indicating that the model had a good accuracy. Further analysis of DCA curve showed that the model had good clinical application value when the risk threshold ranged from 0.05 to 0.70.Conclusion： For prostate cancer patients with PSA≤20 μg/L, bpMRI has a good predictive value for the pelvic lymph node metastasis of prostate cancer with extrocapusular extension, enlargement of pelvic lymph nodes and ISUP grade≥4.
Humans ; Male ; Prostatic Neoplasms/diagnostic imaging* ; Lymphatic Metastasis ; Retrospective Studies ; Nomograms ; Prostate-Specific Antigen/blood* ; Lymph Nodes/pathology* ; Pelvis ; Predictive Value of Tests ; Prostatectomy ; Lymph Node Excision ; Risk Factors ; Magnetic Resonance Imaging ; Logistic Models ; Middle Aged ; Aged

Oropharyngeal squamous cell carcinoma(OPSCC)is a malignant tumor originating from the squamous epithelium of the oro-pharyngeal mucosa,accounting for more than 90％of oropharyngeal malignancies.In recent years,human papillomavirus(HPV)infec-tion has become one of the primary etiological factors of oropharyngeal squamous carcinoma.The incidence of HPV-associated oropharyn-geal squamous carcinoma has been rising annually,with a noticeable trend toward younger populations,posing a significant threat to hu-man health.Due to the distinct biological behavior and clinical characteristics of HPV-associated oropharyngeal squamous carcinoma com-pared to its non-HPV-related counterpart,the diagnostic and treatment strategies for oropharyngeal squamous carcinoma have undergone substantial changes.Prevention and screening for oropharyngeal squamous carcinoma are of critical importance.The diagnostic and treat-ment process involves multi-disciplinary collaboration,including oral and maxillofacial surgery,otolaryngology,head and neck surgery,oncology,radiology and pathology.Based on evidence from clinical practice,a comprehensive,integrated diagnostic and therapeutic ap-proach has been established,centered around the concept of"prevention,screening,diagnosis,treatment,and rehabilitation",covering the entire patient lifecycle and providing a valuable reference for clinical practice.

Objective:To investigate the clinical characteristics, treatment status, and disease outcomes of Chinese patients with multifocal motor neuropathy (MMN).Methods:Inpatients with MMN who were admitted to Huashan Hospital, Shanghai Medical College, Fudan University between January 2014 and April 2024 were enrolled. Baseline information, clinical features, and treatment history were recorded. Disability and functional impairment were assessed using the Inflammatory Neuropathy Cause and Treatment (INCAT) scale.Results:A total of 39 MMN patients were included and classified according to the 2010 European Federation of Neurological Societies/Peripheral Nerve Society criteria: definite MMN (27 cases), probable MMN (3 cases), and possible MMN (9 cases). At onset, 29 cases (29/39, 74.4%) had unilateral upper limb involvement, 5 cases (5/39, 12.8%) had unilateral lower limb involvement, 1 case (1/39, 2.6%) had bilateral lower limb involvement, and 4 cases (4/39, 10.3%) had simultaneous upper and lower limb involvement. By the last follow-up, follow-up duration was 3.4 (5.4) years (range: 0-14.3 years), disease duration was 8.3 (5.9) years (range: 1.2-31.3 years); 27 patients (27/39, 69.2%) exhibited increased limb involvement compared to onset. Segmental conduction block was detected in 35 cases (35/39, 89.7%). Anti-GM1 IgM antibodies were positive in 14 cases (14/31, 45.2%), and cerebrospinal fluid protein-cell dissociation was observed in 6 cases (6/32, 18.8%). Among them, 38 patients were treated with intravenous immunoglobulin (IVIG) during the disease course. Among the 24 patients followed up for>1 year after IVIG initiation, long-term efficacy (≥1 year), medium-short-term efficacy (<1 year), and no efficacy were observed in 16.7% (4/24), 62.5% (15/24), and 20.8% (5/24) of cases, respectively. Patients with persistently positive anti-GM1 IgM antibodies tended to have medium-short-term relief. Cyclophosphamide was used in 7 cases, with long-term improvement in 1 case. One patient achieved sustained improvement after two courses of rituximab. No benefit was observed with plasma exchange, corticosteroids, or other immunosuppressants. The median INCAT score at disease onset was 1 (range: 0-4), while the median pre-immunotherapy INCAT score was 3 (range: 0-5), and at the last follow-up after treatment, the median INCAT score remained 3 (range: 0-5). A statistically significant increase in INCAT scores was observed from disease onset to pretreatment ( U=229.000, P<0.001). However, no statistically significant difference was found between pretreatment and posttreatment INCAT scores ( U=491.500, P=0.880). Conclusions:MMN is a slowly progressive immune-mediated peripheral neuropathy. Early diagnosis and treatment with IVIG are crucial. Evidence for the efficacy of cyclophosphamide and rituximab remains limited.

Oral squamous cell carcinoma(OSCC)is a malignant lesion originating from the oral mucosal squamous epithelium,account-ing for over 80％of oral and maxillofacial malignancies.Key etiological factors include tobacco,alcohol abuse,and betel quid chewing.In China,its incidence has shown an overall upward trend,posing a significant threat to public health.OSCC exhibits high local invasive-ness,making early diagnosis critical for improving prognosis.Its clinical management requires close multidisciplinary collaboration among oral and maxillofacial surgery,head and neck surgery,radiation oncology,medical oncology,reconstructive surgery,radiology,patholo-gy,and nutritional support teams.Given the increasing disease burden of OSCC and rapid development of multidisciplinary collaborative models,an expert panel has formulated this integrated management consensus based on evidence-based medicine and extensive deliber-ation.Centered on the'Prevention-Screening-Diagnosis-Treatment-Rehabilitation'framework,the consensus provides comprehensive guidance for the entire disease course of OSCC patients,aiming to standardize clinical practice.

Oral squamous cell carcinoma(OSCC)is a malignant lesion originating from the oral mucosal squamous epithelium,account-ing for over 80％of oral and maxillofacial malignancies.Key etiological factors include tobacco,alcohol abuse,and betel quid chewing.In China,its incidence has shown an overall upward trend,posing a significant threat to public health.OSCC exhibits high local invasive-ness,making early diagnosis critical for improving prognosis.Its clinical management requires close multidisciplinary collaboration among oral and maxillofacial surgery,head and neck surgery,radiation oncology,medical oncology,reconstructive surgery,radiology,patholo-gy,and nutritional support teams.Given the increasing disease burden of OSCC and rapid development of multidisciplinary collaborative models,an expert panel has formulated this integrated management consensus based on evidence-based medicine and extensive deliber-ation.Centered on the'Prevention-Screening-Diagnosis-Treatment-Rehabilitation'framework,the consensus provides comprehensive guidance for the entire disease course of OSCC patients,aiming to standardize clinical practice.