AIM: To analyze the changes in binocular visual function before and after small incision lenticule extraction(SMILE)in patients with different degrees of myopia.METHODS:A prospective non-randomized controlled study was conducted. A total of 94 patients(188 eyes)who visited the refractive outpatient department of the ophthalmology department of the General Hospital of the PLA from June 2022 to June 2023 and voluntarily chose SMILE were consecutively included. They were grouped according to the degree of myopia, including 24 cases(48 eyes)in the low myopia group(-3.00 D

Immunotherapy for cancer,as an emerging treatment modality,has made significant strides in recent years and has become a crucial therapeutic approach following surgery,radiotherapy,chemotherapy,and targeted therapy.In particular,the clinical utilization of immune checkpoint inhibitors(ICIs)has not only enhanced the survival rates of patients with refractory or recurrent tumors but has also significantly optimized the overall strategy for cancer treatment.However,as the population undergoing cancer immunotherapy continues to grow,this expansion not only yields clinical benefits but also precipitates a range of specific adverse reactions known as immune-related adverse events(irAEs).Pleural effusion is a common and severe complication in cancer patients,significantly affecting both their quality of life and treatment outcomes.Typically,tumor-related pleural effusion is often due to pleural metastasis,with malignant pleural effusion(MPE)characterized by rapid growth,being difficult to control,and tendency for recurrence.With the approval of new drugs and the expansion of indications for existing medications,the number of cancer patients receiving ICIs treatment is increasing,bringing ICIs-related pleural effusion into focus.While ICIs treatment-related pleural effusion is relatively rare in clinical practice,it is closely linked to treatment choices of patients and prognosis.Unlike MPE,the pathogenesis of ICIs treatment-related pleural effusion is more complex,not only involving non-specific immune activation leading to autoimmune inflammatory reactions but also potentially related to nodular pleural granulomatous reactions,eosinophilic chronic pleurisy,and tumor-infiltrating lymphocytes.In terms of diagnosis,ICIs treatment-related pleural effusion is typically diagnosed through exclusion,requiring the exclusion of other causes such as tumor progression,radiotherapy,and chemotherapy-induced pleural effusion,adding complexity and difficulty to the diagnostic process.Treatment for ICIs treatment-related pleural effusion often involves glucocorticoids,tocilizumab,or infliximab,aiming to alleviate symptoms and improve prognosis by suppressing excessive immune reactions.Preventing the occurrence of ICIs treatment-related pleural effusion is equally crucial,necessitating comprehensive patient assessment before ICIs administration and continuous monitoring during treatment to promptly detect and manage potential adverse reactions.Through this comprehensive management approach,the impact of ICIs treatment-related pleural effusion on patient quality of life and treatment outcomes can be minimized,optimizing overall treatment results.This review aimed to explore the pathogenesis,histological features,clinical manifestations,diagnostic methods and treatment strategies of ICIs treatment-related pleural effusion,and delve into the characteristics of ICIs treatment-related pleural effusion,in order to enhance understanding of this complication and provide a reference for clinical practice.

Objective:To investigate the prevalence, comorbidity patterns, and associated factors of cardiometabolic multimorbidity (CMM) in China.Methods:From 2012 to 2015, a total of 34 994 residents aged ≥35 years were enrolled using a stratified multistage random sampling method across 31 provinces, autonomous regions, and municipalities in China. Data were collected through questionnaires, covering demographic characteristics, behavioral and lifestyle factors, and self-reported history of cardiometabolic diseases. CMM was defined as the coexistence of two or more cardiometabolic diseases in the same individual. Association rule analysis using the Apriori algorithm from the arules package was employed to identify strong CMM patterns. Multivariable logistic regression was employed to explore factors associated with CMM.Results:The mean age of the participants was 55.6 years. Among them, 15 926 were male (45.51%). The prevalence of cardiometabolic multimorbidity (CMM) was 11.25% (3 937/34 994). A total of 35 distinct CMM combinations (each with a frequency ≥10) were identified. The most prevalent dyad, triad, and tetrad comorbidity patterns were hypertension+hyperlipidemia (1 036 cases), hypertension+hyperlipidemia+diabetes (352 cases), and hypertension+stroke+hyperlipidemia+diabetes (54 cases), respectively. Nine strong CMM patterns were identified using the Apriori association rule algorithm. Multivariable logistic regression analysis showed that older age (≥70 years: OR=17.39,95% CI 13.92-21.71, P<0.01), junior high school education ( OR=1.31, 95% CI 1.17-1.48, P<0.01), senior high school or above education ( OR=1.45, 95% CI 1.27-1.65, P<0.01), retirement ( OR=3.09, 95% CI 2.76-3.46, P<0.01), unemployment or being laid-off ( OR=1.16, 95% CI 1.06-1.28, P<0.01), a family history of cardiometabolic disease ( OR=4.37, 95% CI 4.04-4.72, P<0.01), regular smoking ( OR=1.38, 95% CI 1.24-1.53, P<0.05), and occasional smoking ( OR=1.21, 95% CI 1.00-1.49, P<0.01) were significantly associated with an increased risk of CMM. Conclusion:The prevalence of cardiometabolic multimorbidity in China is relatively high, with the most common comorbidity patterns involving combinations of hypertension and hyperlipidemia, often accompanied by diabetes and stroke. Older age, retirement status, smoking, and a family history of cardiovascular disease are associated with an increased risk of both single and multiple cardiometabolic conditions. Greater attention should be paid to individuals with a single cardiometabolic disorder due to their elevated risk of developing multimorbidity.

Objective To explore the distribution and characteristics of traditional Chinese medicine(TCM)syndromes in patients with adenomyosis.Methods A retrospective analysis was conducted on the data collected from patients with adenomyosis between December 2019 and April 2022 based on a cross-sectional survey.Variables included age,body mass index(BMI),disease duration,geographical region,dysmenorrhea,menstrual flow,diagnosis and treatment goals,history of adenomyosis-related surgery,postoperative recurrence,and carbohydrate antigen 125(CA125)and carbohydrate antigen 199(CA199)levels.The distribution pattern of TCM syndromes,including general information of patients with different syndromes,CA125 and CA199 levels,were analyzed.The relationship between syndromes and age,BMI,duration of disease,geographic region,and history of adenomyosis-related surgery were analyzed using the multinomial logistic regression.Results A total of 1,816 patients with adenomyosis were included.The most common TCM syndrome was syndrome of cold coagulation and blood stasis(36.84%).The other four TCM syndromes,ranked by frequency,were syndrome of qi stagnation and blood stasis(25.39%),syndrome of blood stasis due to qi deficiency(17.35%),syndrome of kidney deficiency and blood stasis(15.97%),and syndrome of intermin-gled phlegm and blood stasis(4.46%).Significant differences in age,disease duration,and BMI were observed among patients with different TCM syndromes(P<0.05).Patients with syndrome of cold congelation and blood stasis,syndrome of kidney deficiency and blood stasis,were younger than those with syndrome of qi stagnation and blood stasis.Patients with syndrome of cold congelation and blood stasis had a longer disease duration than those with syndrome of blood stasis due to qi deficiency.Patients with syndrome of blood stasis due to qi deficiency had lower BMI(P<0.05)than those with syndrome of intermin-gled phlegm and blood stasis.The most common symptom in North China,East China,Southwest China,Northwest China,and Northeast China was syndrome of cold congelation and blood stasis,accounting for 45.39%,35.98%,30.33%,41.38%,and 50.00%,respectively.The most common syndrome in Southern and Central China was syndrome of qi stagnation and blood stasis,accounting for 31.34%and 36.23%respectively.Differences in syndrome distribution were observed between patients in East,Southwest,South,and Central China and those in North China(P<0.05).Syndrome distribution also varied significantly across different diagnosis and treatment goals,as well as menstrual conditions(P<0.05).For treatment goals such as pain relief,lesion control,menstrual flow reduction,and recurrence prevention,the dominant syndromes were syndrome of cold congelation and blood stasis(40.67%,37.13%,36.95%,and 43.35%,respectively)and syndrome of qi stagnation and blood stasis(29.35%,26.39%,26.10%,and 25.75%,respectively).Among patients seeking assisted pregnancy,the primary syndromes were syndrome of cold congelation and blood stasis(41.12%)and syndrome of kidney deficiency and blood stasis(18.69%).Patients with dysmenorrhea were mostly diagnosed with syndrome of cold congelation and blood stasis(39.95%)and syndrome of qi stagnation and blood stasis(28.52%).Differences in syndrome distribution were observed between patients with small and large menstrual volume,with a higher proportion of syndrome of kidney deficiency and blood stasis in patients with small menstrual volume(P<0.05).However,no significant difference was noted in the distribution of TCM syndromes in different treatment stages.Additionally,no statistical significance was observed in the CA125 and CA199 levels among patients with various TCM syndromes.Multinomial logistic regression analysis revealed that compared with syndrome of cold congelation and blood stasis,the course of disease was the influencing factor of syndrome of blood stasis due to qi deficiency,BMI was the influencing factor of syndrome of qi stagnation and blood stasis and syndrome of intermin-gled phlegm and blood stasis,and geography was the influencing factor of syndrome of blood stasis due to qi deficiency,syndrome of qi stagnation and blood stasis,syndrome of kidney deficiency and blood stasis,and syndrome of intermin-gled phlegm and blood stasis.Conclusion Syndrome of cold coagulation and blood stasis is the most prevalent TCM syndrome among patients with adenomyosis,and the distribution of TCM syndromes has a specific regularity.The syndromes are independently correlated with region,disease duration,and BMI.

Immunotherapy for cancer,as an emerging treatment modality,has made significant strides in recent years and has become a crucial therapeutic approach following surgery,radiotherapy,chemotherapy,and targeted therapy.In particular,the clinical utilization of immune checkpoint inhibitors(ICIs)has not only enhanced the survival rates of patients with refractory or recurrent tumors but has also significantly optimized the overall strategy for cancer treatment.However,as the population undergoing cancer immunotherapy continues to grow,this expansion not only yields clinical benefits but also precipitates a range of specific adverse reactions known as immune-related adverse events(irAEs).Pleural effusion is a common and severe complication in cancer patients,significantly affecting both their quality of life and treatment outcomes.Typically,tumor-related pleural effusion is often due to pleural metastasis,with malignant pleural effusion(MPE)characterized by rapid growth,being difficult to control,and tendency for recurrence.With the approval of new drugs and the expansion of indications for existing medications,the number of cancer patients receiving ICIs treatment is increasing,bringing ICIs-related pleural effusion into focus.While ICIs treatment-related pleural effusion is relatively rare in clinical practice,it is closely linked to treatment choices of patients and prognosis.Unlike MPE,the pathogenesis of ICIs treatment-related pleural effusion is more complex,not only involving non-specific immune activation leading to autoimmune inflammatory reactions but also potentially related to nodular pleural granulomatous reactions,eosinophilic chronic pleurisy,and tumor-infiltrating lymphocytes.In terms of diagnosis,ICIs treatment-related pleural effusion is typically diagnosed through exclusion,requiring the exclusion of other causes such as tumor progression,radiotherapy,and chemotherapy-induced pleural effusion,adding complexity and difficulty to the diagnostic process.Treatment for ICIs treatment-related pleural effusion often involves glucocorticoids,tocilizumab,or infliximab,aiming to alleviate symptoms and improve prognosis by suppressing excessive immune reactions.Preventing the occurrence of ICIs treatment-related pleural effusion is equally crucial,necessitating comprehensive patient assessment before ICIs administration and continuous monitoring during treatment to promptly detect and manage potential adverse reactions.Through this comprehensive management approach,the impact of ICIs treatment-related pleural effusion on patient quality of life and treatment outcomes can be minimized,optimizing overall treatment results.This review aimed to explore the pathogenesis,histological features,clinical manifestations,diagnostic methods and treatment strategies of ICIs treatment-related pleural effusion,and delve into the characteristics of ICIs treatment-related pleural effusion,in order to enhance understanding of this complication and provide a reference for clinical practice.

Objective To explore the distribution and characteristics of traditional Chinese medicine(TCM)syndromes in patients with adenomyosis.Methods A retrospective analysis was conducted on the data collected from patients with adenomyosis between December 2019 and April 2022 based on a cross-sectional survey.Variables included age,body mass index(BMI),disease duration,geographical region,dysmenorrhea,menstrual flow,diagnosis and treatment goals,history of adenomyosis-related surgery,postoperative recurrence,and carbohydrate antigen 125(CA125)and carbohydrate antigen 199(CA199)levels.The distribution pattern of TCM syndromes,including general information of patients with different syndromes,CA125 and CA199 levels,were analyzed.The relationship between syndromes and age,BMI,duration of disease,geographic region,and history of adenomyosis-related surgery were analyzed using the multinomial logistic regression.Results A total of 1,816 patients with adenomyosis were included.The most common TCM syndrome was syndrome of cold coagulation and blood stasis(36.84%).The other four TCM syndromes,ranked by frequency,were syndrome of qi stagnation and blood stasis(25.39%),syndrome of blood stasis due to qi deficiency(17.35%),syndrome of kidney deficiency and blood stasis(15.97%),and syndrome of intermin-gled phlegm and blood stasis(4.46%).Significant differences in age,disease duration,and BMI were observed among patients with different TCM syndromes(P<0.05).Patients with syndrome of cold congelation and blood stasis,syndrome of kidney deficiency and blood stasis,were younger than those with syndrome of qi stagnation and blood stasis.Patients with syndrome of cold congelation and blood stasis had a longer disease duration than those with syndrome of blood stasis due to qi deficiency.Patients with syndrome of blood stasis due to qi deficiency had lower BMI(P<0.05)than those with syndrome of intermin-gled phlegm and blood stasis.The most common symptom in North China,East China,Southwest China,Northwest China,and Northeast China was syndrome of cold congelation and blood stasis,accounting for 45.39%,35.98%,30.33%,41.38%,and 50.00%,respectively.The most common syndrome in Southern and Central China was syndrome of qi stagnation and blood stasis,accounting for 31.34%and 36.23%respectively.Differences in syndrome distribution were observed between patients in East,Southwest,South,and Central China and those in North China(P<0.05).Syndrome distribution also varied significantly across different diagnosis and treatment goals,as well as menstrual conditions(P<0.05).For treatment goals such as pain relief,lesion control,menstrual flow reduction,and recurrence prevention,the dominant syndromes were syndrome of cold congelation and blood stasis(40.67%,37.13%,36.95%,and 43.35%,respectively)and syndrome of qi stagnation and blood stasis(29.35%,26.39%,26.10%,and 25.75%,respectively).Among patients seeking assisted pregnancy,the primary syndromes were syndrome of cold congelation and blood stasis(41.12%)and syndrome of kidney deficiency and blood stasis(18.69%).Patients with dysmenorrhea were mostly diagnosed with syndrome of cold congelation and blood stasis(39.95%)and syndrome of qi stagnation and blood stasis(28.52%).Differences in syndrome distribution were observed between patients with small and large menstrual volume,with a higher proportion of syndrome of kidney deficiency and blood stasis in patients with small menstrual volume(P<0.05).However,no significant difference was noted in the distribution of TCM syndromes in different treatment stages.Additionally,no statistical significance was observed in the CA125 and CA199 levels among patients with various TCM syndromes.Multinomial logistic regression analysis revealed that compared with syndrome of cold congelation and blood stasis,the course of disease was the influencing factor of syndrome of blood stasis due to qi deficiency,BMI was the influencing factor of syndrome of qi stagnation and blood stasis and syndrome of intermin-gled phlegm and blood stasis,and geography was the influencing factor of syndrome of blood stasis due to qi deficiency,syndrome of qi stagnation and blood stasis,syndrome of kidney deficiency and blood stasis,and syndrome of intermin-gled phlegm and blood stasis.Conclusion Syndrome of cold coagulation and blood stasis is the most prevalent TCM syndrome among patients with adenomyosis,and the distribution of TCM syndromes has a specific regularity.The syndromes are independently correlated with region,disease duration,and BMI.

Objective:To investigate the prevalence, comorbidity patterns, and associated factors of cardiometabolic multimorbidity (CMM) in China.Methods:From 2012 to 2015, a total of 34 994 residents aged ≥35 years were enrolled using a stratified multistage random sampling method across 31 provinces, autonomous regions, and municipalities in China. Data were collected through questionnaires, covering demographic characteristics, behavioral and lifestyle factors, and self-reported history of cardiometabolic diseases. CMM was defined as the coexistence of two or more cardiometabolic diseases in the same individual. Association rule analysis using the Apriori algorithm from the arules package was employed to identify strong CMM patterns. Multivariable logistic regression was employed to explore factors associated with CMM.Results:The mean age of the participants was 55.6 years. Among them, 15 926 were male (45.51%). The prevalence of cardiometabolic multimorbidity (CMM) was 11.25% (3 937/34 994). A total of 35 distinct CMM combinations (each with a frequency ≥10) were identified. The most prevalent dyad, triad, and tetrad comorbidity patterns were hypertension+hyperlipidemia (1 036 cases), hypertension+hyperlipidemia+diabetes (352 cases), and hypertension+stroke+hyperlipidemia+diabetes (54 cases), respectively. Nine strong CMM patterns were identified using the Apriori association rule algorithm. Multivariable logistic regression analysis showed that older age (≥70 years: OR=17.39,95% CI 13.92-21.71, P<0.01), junior high school education ( OR=1.31, 95% CI 1.17-1.48, P<0.01), senior high school or above education ( OR=1.45, 95% CI 1.27-1.65, P<0.01), retirement ( OR=3.09, 95% CI 2.76-3.46, P<0.01), unemployment or being laid-off ( OR=1.16, 95% CI 1.06-1.28, P<0.01), a family history of cardiometabolic disease ( OR=4.37, 95% CI 4.04-4.72, P<0.01), regular smoking ( OR=1.38, 95% CI 1.24-1.53, P<0.05), and occasional smoking ( OR=1.21, 95% CI 1.00-1.49, P<0.01) were significantly associated with an increased risk of CMM. Conclusion:The prevalence of cardiometabolic multimorbidity in China is relatively high, with the most common comorbidity patterns involving combinations of hypertension and hyperlipidemia, often accompanied by diabetes and stroke. Older age, retirement status, smoking, and a family history of cardiovascular disease are associated with an increased risk of both single and multiple cardiometabolic conditions. Greater attention should be paid to individuals with a single cardiometabolic disorder due to their elevated risk of developing multimorbidity.

Objective:To explore the association between cognitive function and the level of gamma-amino-butyric acid(GABA)in anterior cingulate cortex(ACC)before and after treatment in patients with major depres-sion disorder.Methods:Totally 31 medication-naive patients with major depression disorder meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)and 33 normal controls were col-lected.Each eligible patient received treatment with selective serotonin reuptake inhibitor agents for 8 weeks.The MATRICS Consensus Cognitive Battery(MCCB)was used to evaluate the cognitive function.By means of 1H magnetic resonance spectroscopy,anterior cingulate cortex GABA concentrations were measured.Results:At base-line,the concentration of ACC GABA relative to water(GABA+/W)was lower in the patient group than in the control group(P＜0.05)and increased after treatment(P＜0.05).ACC GABA+/W was negatively associated with verbal learning and visual memory score in patient group at baseline(correlation coefficient and P value were r=-0.40,P＜0.05;r=-0.42,P＜0.05,respectively).The ACC GABA+/W difference resulted of treatment in patient group was positively associated with the difference of working memory score and the difference of reasoning and problem-solving score(correlation coefficient and P value were r=0.58,P＜0.05;r=0.66,P＜0.05,respec-tively).Conclusion:The cognitive dysfunction of patients with major depression disorder may not be related to the degree of depression and anxiety.And improvement of cognitive function may be associated with increase of ACC GABA concentrations.

ObjectiveTo explore the distribution and characteristics of traditional Chinese medicine （TCM） syndromes in patients with endometriosis （EMS）. MethodA cross-sectional survey was conducted to analyze the characteristics of TCM syndromes in 1 895 cases of EMS in hospitals of 19 provinces， autonomous regions， and municipalities. ResultAmong the 1 895 patients， Qistagnation and blood stasis syndrome accounted for the highest proportion， followed by Qi deficiency and blood stasis syndrome， cold coagulation and blood stasis syndrome， and kidney deficiency and blood stasis syndrome. The distribution of TCM syndrome types of patients with EMS in different regions， different treatment stages， and different disease types and with different therapeutic goals was different， and the differences were statistically significant. However， under different conditions， the Qi stagnation and blood stasis syndrome accounted for the highest proportion. Under the stratification of different regions， the cold coagulation and blood stasis syndrome in north China was relatively high， the kidney deficiency and blood stasis syndrome in south China was relatively high， and the combined phlegm and stasis syndrome was relatively high in southwest China. Different diagnosis and treatment goals corresponded to different clinical syndromes. With pelvic pain as the main manifestation， the proportion of cold coagulation and blood stasis syndrome was higher. The proportion of kidney deficiency and blood stasis syndrome was higher in married patients with infertility. Patients with the main diagnosis and treatment goals of controlling mass and inhibiting recurrence had a higher proportion of Qi deficiency and blood stasis syndrome. In different treatment stages， the proportion of Qi deficiency and blood stasis syndrome in postoperative patients and those with recurrent EMS was higher. Among different disease types， the Qi deficiency and blood stasis syndrome accounted for a higher proportion in patients with ovarian endometriosis （OEM）. The cold coagulation and blood stasis syndrome accounted for a higher proportion in patients with deep invasive endometriosis （DIE）. The kidney deficiency and blood stasis syndrome accounted for a higher proportion in patients with peritoneal EMS. There were significant differences in age， body mass index （BMI）， and course of disease among patients with different syndromes. Patients with Qi deficiency and blood stasis syndrome was relatively older， and their course of the disease was relatively long. Patients with combined phlegm and stasis syndrome had relatively high BMI. There was no significant difference in CA125 and CA199 levels among all syndrome types. ConclusionThe distribution of TCM syndromes of EMS has a certain regularity， and there are differences in regional distribution， therapeutic goals， treatment stages， and disease types（P<0.05）. However， the Qi stagnation and blood stasis syndrome accounts for a large proportion under different conditions， suggesting that Qi stagnation is the key link of EMS. In the early stage， the team took relieving depression and activating blood as the primary treatment， and created Huoxue Xiaoyi prescription， which was the core prescription for the treatment of EMS with Qi stagnation and blood stasis syndrome， achieving good clinical effect. At the same time， it is emphasized that EMS treatment should be integrated into the concept of chronic disease management and combined with health management. Through psychological counseling， cognitive behavior intervention， popular science lectures， and other methods， it is advised to adjust the emotion of patients with EMS， thereby increasing the curative effect. This study is expected to provide references for the clinical treatment of EMS.