AIM:To evaluate the effectiveness of EYESI binocular indirect ophthalmoscope simulation system as a training platform for fundus examination skills of general practitioner.METHODS:Prospective randomized study. A total of 40 general practitioners who received clinical ophthalmology training at Shenzhen Eye Hospital from January 2021 to December 2024 were selected and randomly divided into two groups by random number table method, with 20 cases in the study group and 20 cases in the control group. The study group was trained by EYESI binocular indirect ophthalmoscope simulation system and the control group was trained by conventional teaching. Training effects of the two groups were analyzed.RESULTS: The general information of the two groups was comparable. Through training with the EYESI binocular indirect ophthalmoscope simulator, the study group showed significant improvements in total examination and drawing scores compared to pre-training results(all P<0.001). Additionally, examination duration, retinal light exposure time, and drawing time were all significantly shorter than those before training(all P<0.001).The study group achieved significantly higher total examination and drawing scores than the control group during the EYESI binocular indirect ophthalmoscope simulator assessment(all P<0.001). Furthermore, examination duration, retinal light exposure time, and drawing time were all significantly shorter in the study group compared to the control group(all P<0.001). Moreover, ratings for the novelty of the training method and overall satisfaction with the training were significantly higher in the study group than in the control group(all P<0.001); while the perceived psychological stress during training was significantly lower in the study group(P<0.001).CONCLUSION:The EYESI binocular indirect ophthalmoscope simulaton system effectively enhances both the proficiency in fundus examination skills and overall training satisfaction among general practitioners.

Objective:To investigate the effect of TCF1+CD8+T cells on the prognosis of nasopharyngeal carcinoma(NPC)pa-tients undergoing immunotherapy.Methods:A retrospective study was conducted on 108 NPC patients admitted to Anyang Cancer Hospital from January 2018 to April 2020.Pathological findings and clinical data were collected,and multiple immunofluorescence staining was utilized to detect TCF1+CD8+T cell levels in tumor tissue.Cell counts and the proportion of positive cells were measured,and the optimal cut-off value was determined using a time-dependent receiver operating characteristic(ROC)curve.Patients were clas-sified into high expression group and low expression group according to the cut-off value.The general information and survival status were compared between two groups,and univariate and multivariate Cox regression analysis were performed to screen the influencing factors of patient prognosis.Results:The optimal cut-off value was determined using ROC curve.A cut-off value of 0.34%for TCF1+CD8+T cell area under the curve(AUC)=0.653 resulted in a sensitivity of 73.5%and a specificity of 43.7%.Based on the opti-mal cut-off value,33 patients with TCF1+CD8+T cell beyond 0.34%were included in high expression group,and the remaining 75 pa-tients were included in low expression group.The proportion of TCF1+CD8+T cells was(0.43±0.09)%in high expression group and(0.21±0.08)%in low expression group.Comparison of general data yielded that the gender,age,body mass index(BMI),clinical stage,and pathological classification showed no statistical difference between two groups(P>0.05),while the percentage of patients with T stage of T3 and T4,N stage of N2 and N3,and M stage of M1 in high expression group were smaller than that in low expression group(P<0.05).The 24-month survival rate was 81.82%(27/33)in high expression group and 74.67%(56/75)in low expression group,with no statistical difference between two groups(χ2=0.658 8,P=0.417 0).Univariate and multivariate Cox regression analysis found that T stage,N stage and M stage were independent risk factors affecting the prognosis of patients,and TCF1+CD8+T expression was a protective factor.ROC curve indicated that the AUC,sensitivity and specificity of TCF1+CD8+T expression in predicting death of NPC patients undergoing immunotherapy was 0.674,69.7%and 65.3%,while the AUC,sensitivity and specificity of TCF1+CD8+T ex-pression combined with TNM stage in predicting death was 0.809,75.8%and 84.0%,respectively.Conclusion:NPC patients with higher proportion of TCF1+CD8+T cells and lower TNM stage have higher 24-month survival rate after immunotherapy,and the above parameters are of great predictive value for patient prognosis.

Objective To explore the application value of three dimensions(3D)visualization combined with ultrasound(US)in percutaneous transhepatic cholangial drainage(PTCD).Methods A retrospective analysis was conducted on clinical data from 44 PTCD procedures performed by our team between January 2020 and March 2025.Twenty-one cases before January 2023 underwent conventional US-guided PTCD(US group),while 23 subsequent cases received 3D visualization-assisted US-guided PTCD(3D+US group).Both groups had comparable baseline characteristics.For the3D+US group,preoperative upper abdominal CT(non-contrast+contrast-enhanced)data were imported into the open-source 3D software 3D Slicer 5.6.2 to reconstruct individualized 3D models for preoperative puncture planning.Outcomes including puncture success rate,procedure time,times of puncture,therapeutic efficacy,and complications were compared between the two groups.Results Compared with the US group,the 3D+US group required fewer puncture times(1/2/3 times:19/4/0 cases vs.10/9/2 cases,Z=-2.602,P=0.009)and shorter procedure time[(38.8±12.2)min vs.(56.6±14.8)min,t=-4.372,P=0.000].No significant differences were observed in puncture success rate[100.0%(23/23)vs.90.5%(19/21),P=0.222],therapeutic efficacy(markedly effective/effective/ineffective:13/9/1 cases vs.10/9/2 cases,Z=-0.688,P=0.492),or complication rate[8.7%(2/23)vs.19.0%(4/21),χ2=0.313,P=0.576].Conclusion 3D visualization combined with US guidance for PTCD is safe and effective,facilitating reduced procedure time and fewer puncture times.

Objective To explore the feasibility of protocol with low tube voltage,low contrast agent dose,low injection rate,and low trigger threshold based on body weight in coronary computed tomography angiography(CCTA).Methods Patients suspected with coronary heart disease who underwent 320 rows of CCTA were prospectively selected.They were divided into 4 groups:＜60 kg,60-70 kg,71-80 kg,＞80 kg based on different body weights,120 cases for each group,then were randomly divided into experimental group and control group using a random number table method,with 60 patients in each group.Each case in the control group had a tube voltage of 120 kV and a trigger threshold of 240 HU;each case in the experimental group had a tube voltage of 100 kV and a trigger threshold of 190 HU.According to the CCTA application guidelines,the iodine flow rate was used to determine the contrast agent injection rate in the control group,while the injection rate in the experimental group was reduced by 30%.Using an injection time of 12 s,the control group's contrast agent dose was obtained,and that of the experimental group decreased by 30%.Two radiologists evaluated the CT values,contrast-to-noise ratio(CNR),image quality score,and signal-to-noise ratio(SNR)of the middle segment of the right coronary artery,proximal segment of the left anterior descending branch,and proximal segment of the left circumflex branch,as well as compared the effective dose(ED)of volume scanning and threshold monitoring sequences.One-way ANOVA,independent sample t-test,and Mann-Whitney U-test were used to evaluate the differences in each parameter.Results There were no statistically significant differences in general information and subjective image scores between the experimental group and the control group(P＞0.05).There were no statistically significant differences in CT values,CNR,and SNR between the experimental group and the control group at different body weights for the middle segment of the right coronary artery,the proximal segment of the left anterior descending branch,and the proximal segment of the left circumflex branch(P＞0.05).In terms of radiation dose,the comparison between the control group and the experimental group at the same body weights showed statistically significant differences both in volume scanning and threshold monitoring sequences(P＜0.001),and the ED of the experimental group was significantly lower than that of the control group.Conclusion The protocol with low tube voltage,low contrast agent dose,low injection rate,and low trigger threshold determined based on different body weights can achieve satisfactory image quality for CCTA,while significantly reducing the radiation dose of volume scanning and threshold monitoring sequences.

Objective To explore the feasibility of protocol with low tube voltage,low contrast agent dose,low injection rate,and low trigger threshold based on body weight in coronary computed tomography angiography(CCTA).Methods Patients suspected with coronary heart disease who underwent 320 rows of CCTA were prospectively selected.They were divided into 4 groups:＜60 kg,60-70 kg,71-80 kg,＞80 kg based on different body weights,120 cases for each group,then were randomly divided into experimental group and control group using a random number table method,with 60 patients in each group.Each case in the control group had a tube voltage of 120 kV and a trigger threshold of 240 HU;each case in the experimental group had a tube voltage of 100 kV and a trigger threshold of 190 HU.According to the CCTA application guidelines,the iodine flow rate was used to determine the contrast agent injection rate in the control group,while the injection rate in the experimental group was reduced by 30%.Using an injection time of 12 s,the control group's contrast agent dose was obtained,and that of the experimental group decreased by 30%.Two radiologists evaluated the CT values,contrast-to-noise ratio(CNR),image quality score,and signal-to-noise ratio(SNR)of the middle segment of the right coronary artery,proximal segment of the left anterior descending branch,and proximal segment of the left circumflex branch,as well as compared the effective dose(ED)of volume scanning and threshold monitoring sequences.One-way ANOVA,independent sample t-test,and Mann-Whitney U-test were used to evaluate the differences in each parameter.Results There were no statistically significant differences in general information and subjective image scores between the experimental group and the control group(P＞0.05).There were no statistically significant differences in CT values,CNR,and SNR between the experimental group and the control group at different body weights for the middle segment of the right coronary artery,the proximal segment of the left anterior descending branch,and the proximal segment of the left circumflex branch(P＞0.05).In terms of radiation dose,the comparison between the control group and the experimental group at the same body weights showed statistically significant differences both in volume scanning and threshold monitoring sequences(P＜0.001),and the ED of the experimental group was significantly lower than that of the control group.Conclusion The protocol with low tube voltage,low contrast agent dose,low injection rate,and low trigger threshold determined based on different body weights can achieve satisfactory image quality for CCTA,while significantly reducing the radiation dose of volume scanning and threshold monitoring sequences.

Objective To explore the application value of three dimensions(3D)visualization combined with ultrasound(US)in percutaneous transhepatic cholangial drainage(PTCD).Methods A retrospective analysis was conducted on clinical data from 44 PTCD procedures performed by our team between January 2020 and March 2025.Twenty-one cases before January 2023 underwent conventional US-guided PTCD(US group),while 23 subsequent cases received 3D visualization-assisted US-guided PTCD(3D+US group).Both groups had comparable baseline characteristics.For the3D+US group,preoperative upper abdominal CT(non-contrast+contrast-enhanced)data were imported into the open-source 3D software 3D Slicer 5.6.2 to reconstruct individualized 3D models for preoperative puncture planning.Outcomes including puncture success rate,procedure time,times of puncture,therapeutic efficacy,and complications were compared between the two groups.Results Compared with the US group,the 3D+US group required fewer puncture times(1/2/3 times:19/4/0 cases vs.10/9/2 cases,Z=-2.602,P=0.009)and shorter procedure time[(38.8±12.2)min vs.(56.6±14.8)min,t=-4.372,P=0.000].No significant differences were observed in puncture success rate[100.0%(23/23)vs.90.5%(19/21),P=0.222],therapeutic efficacy(markedly effective/effective/ineffective:13/9/1 cases vs.10/9/2 cases,Z=-0.688,P=0.492),or complication rate[8.7%(2/23)vs.19.0%(4/21),χ2=0.313,P=0.576].Conclusion 3D visualization combined with US guidance for PTCD is safe and effective,facilitating reduced procedure time and fewer puncture times.

Objective:To investigate the effect of TCF1+CD8+T cells on the prognosis of nasopharyngeal carcinoma(NPC)pa-tients undergoing immunotherapy.Methods:A retrospective study was conducted on 108 NPC patients admitted to Anyang Cancer Hospital from January 2018 to April 2020.Pathological findings and clinical data were collected,and multiple immunofluorescence staining was utilized to detect TCF1+CD8+T cell levels in tumor tissue.Cell counts and the proportion of positive cells were measured,and the optimal cut-off value was determined using a time-dependent receiver operating characteristic(ROC)curve.Patients were clas-sified into high expression group and low expression group according to the cut-off value.The general information and survival status were compared between two groups,and univariate and multivariate Cox regression analysis were performed to screen the influencing factors of patient prognosis.Results:The optimal cut-off value was determined using ROC curve.A cut-off value of 0.34%for TCF1+CD8+T cell area under the curve(AUC)=0.653 resulted in a sensitivity of 73.5%and a specificity of 43.7%.Based on the opti-mal cut-off value,33 patients with TCF1+CD8+T cell beyond 0.34%were included in high expression group,and the remaining 75 pa-tients were included in low expression group.The proportion of TCF1+CD8+T cells was(0.43±0.09)%in high expression group and(0.21±0.08)%in low expression group.Comparison of general data yielded that the gender,age,body mass index(BMI),clinical stage,and pathological classification showed no statistical difference between two groups(P>0.05),while the percentage of patients with T stage of T3 and T4,N stage of N2 and N3,and M stage of M1 in high expression group were smaller than that in low expression group(P<0.05).The 24-month survival rate was 81.82%(27/33)in high expression group and 74.67%(56/75)in low expression group,with no statistical difference between two groups(χ2=0.658 8,P=0.417 0).Univariate and multivariate Cox regression analysis found that T stage,N stage and M stage were independent risk factors affecting the prognosis of patients,and TCF1+CD8+T expression was a protective factor.ROC curve indicated that the AUC,sensitivity and specificity of TCF1+CD8+T expression in predicting death of NPC patients undergoing immunotherapy was 0.674,69.7%and 65.3%,while the AUC,sensitivity and specificity of TCF1+CD8+T ex-pression combined with TNM stage in predicting death was 0.809,75.8%and 84.0%,respectively.Conclusion:NPC patients with higher proportion of TCF1+CD8+T cells and lower TNM stage have higher 24-month survival rate after immunotherapy,and the above parameters are of great predictive value for patient prognosis.

Background and objective Lung cancer is a common malignant tumor of the lung.To explore the molecular mechanism of the occurrence and development of lung cancer is a hot topic in current research.Cyclic RNA D1(CircCCND1)is highly expressed in lung cancer and may be a potential target for the treatment of lung cancer.The aim of this study was to investigate the effect of CircCCND1 on the malignant biological behaviors of lung cancer cells by regulat-ing the miR-340-5p/transforming growth factor β-induced factor homeobox 1(TGIF1)axis.Methods The expression of CircCCND1,miR-340-5p,and TGIF1 mRNA in human normal lung epithelial cells BEAS-2B and human lung cancer H446 cells were detected.H446 cells cultured in vitro were randomly divided into control group,CircCCND1 siRNA group,miR-340-5p mimics group,negative control group,and CircCCND1 siRNA+miR-340-5p inhibitor group.Cell proliferation,mito-chondrial membrane potential,apoptosis,migration,and invasion were detected,and the expressions of CircCCND1,miR-340-5p,TGIF1 mRNA,BCL2-associated X protein(Bax),cleaved Caspase-3,N-cadherin,E-cadherin,and TGIF1 proteins in each group were detected.The targeting relationship of miR-340-5p with CircCCND1 and TGIF1 was verified.Results Compared with BEAS-2B cells,CircCCND1 and TGIF1 mRNA were increased in H446 cells,and miR-340-5p expression was decreased(P＜0.05).Knocking down CircCCND1 or up-regulating the expression of miR-340-5p inhibited the proliferation,migration and invasion of H446 cells,decreased the expression of TGIF1 mRNA and TGIF 1 protein,and promoted cell apop-tosis.Down-regulation of miR-340-5p could antagonize the inhibitory effect of CircCCND1 knockdown on the malignant bio-logical behavior of H446 lung cancer cells.CircCCND1 may target the down-regulation of miR-340-5p,and miR-340-5p may target the down-regulation of TGIF 1.Conclusion Knocking down CircCCND1 can inhibit the malignant behaviors of lung cancer H446 cells,which may be achieved through the regulation of miR-340-5p/TGIF1 axis.

Objective:To explore the clinical application of portable head and neck magnetic resonance imaging (MRI) device in neurosurgery.Methods:A total of 213 patients with brain diseases who were scanned by portable head and neck MRI device in Center of Neurosurgery, Zhujiang Hospital, Southern Medical University from June to September 2022 were selected. The portable head and neck MRI images and 3.0T conventional MRI images of 10 randomly selected patients were compared; the differences in signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of different sequences were analyzed. Thirty-one patients accepted tracheal intubation/tracheotomy, or ventilator-assisted breathing were selected as special patient group, and another 30 patients were as general patient group; the differences in comprehensive diagnostic scores of portable head and neck MRI images were compared. Noise intensity differences in different sequences between 3.0T conventional MRI and portable head and neck MRI were statistically compared. Twenty hospitalized volunteers with normal hearing in our center from July to August 2022 were selected, conventional 3.0T MRI and portable head and neck MRI were performed successively, and the noise intensity of different sequences in them was evaluated by using a 5-point system.Results:Compared with those in 3.0T conventional MRI images, the SNR and CNR of T1WI, T2WI, and Liquid attenuated reverse recovery sequence (FLAIR) sequences in portable head and neck MRI images were significantly lower ( P<0.05). No significant difference was noted in the comprehensive diagnostic scores of portable head and neck MRI images between special patients and general patients ( P>0.05). Compared with that in the 3.0T conventional MRI, the noise intensity of different sequences in portable head and neck MRI was significantly reduced ( P<0.05). These volunteers had significantly reduced noise intensity scores of different sequences in portable head and neck MRI compared with that in conventional 3.0T MRI ( P<0.05). Conclusion:Portable head and neck MRI device is easy to use, enjoying high safety, imaging quality and suitability, which meets the clinical needs for neurosurgery patients.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.