Objective:To investigate the clinical value of spherical lens with 0.05 D intervals in optometry for small incision lenticule extraction (SMILE) in myopic eyes.Methods:A randomized controlled clinical study was conducted.Sixty patients (120 eyes) with low to moderate myopia and myopic astigmatism who underwent SMILE in the 989th Hospital of the PLA from June 2021 to February 2022 were enrolled.The patients were randomly divided into 0.05 D interval group (optometry with spherical lens at 0.05 D interval) and 0.25 D interval group (optometry with spherical lens at 0.25 D interval), with 30 cases (60 eyes) in each group.There was no significant difference in matched age, sphericity, cylindricity, and best corrected visual acuity (BCVA) (all at P>0.05). The preoperative monocular red-green balance, 1- and 3-month postoperative monocular red-green balance, uncorrected visual acuity and spherical equivalent of both groups were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the 989th Hospital of the PLA (No.WZLL-2021-034). Written informed consent was obtained from each subject before any medical examination. Results:The preoperative red-green balance rate in 0.05 D interval group was 95.00%(57/60), which was higher than 35.00%(21/60) in 0.25 D interval group, showing a statistically significant difference ( Wald χ2=17.642, P<0.001). The 1- and 3-month postoperative red-green balance rates in 0.05 D interval group were 63.33%(38/60) and 56.67%(34/60), which were higher than 23.33%(14/60) and 21.67%(13/60) in 0.25 D interval group respectively, showing statistically significant differences ( Wald χ2=9.137, P=0.003; Wald χ2=7.483, P=0.006). The 1- and 3-month postoperative visual acuity in 0.05 D interval group were -0.1(-0.1, -0.1) and -0.1(-0.1, -0.1), which were higher than 0.0(-0.1, 0.0) and -0.1(-0.1, 0.0) in 0.25 D interval group respectively, showing statistically significant differences ( Wald χ2=11.624, P=0.001; Wald χ2=12.841, P<0.001). The 1- and 3-month postoperative spherical equivalent were -0.07(-0.25, 0.13)D and -0.13(-0.25, 0.13)D in 0.05 D interval group, which were higher than -0.13(-0.38, 0.25)D and -0.13(-0.38, 0.25)D in 0.25 D interval group respectively, showing no statistically significant difference between the two groups ( Wald χ2=0.029, P=0.866; Wald χ2=0.189, P=0.664). Conclusions:Compared with spherical lens at 0.25 D interval, 0.05 D interval can improve the accuracy of preoperative and postoperative red-green balance rate and postoperative visual acuity in patients with low to moderate myopia who undergo SMILE.

Objective:To explore the feasibility and clinical efficacy of oblique lateral interbody fusion (OLIF) in the treatment of adjacent segment disease (ASDis).Methods:Retrospective analysis was conducted on the data of 31 patients with ASDis treated by OLIF in four medical centers from June 2015 to December 2018. There were 17 males and 14 females. The average age was (65.7±3.4) years (range, 59 to 75 years). 19 cases received single-segment fixed fusion, 11 cases received double-segment fixed fusion and 1 case received three-segment fixed fusion. Original fixed fusion site: 1 case of L 1, 2, 3 cases of L 3, 4, 11 cases of L 4, 5, 4 cases of L 5S 1, 6 cases of L 3-L 5, 5 cases of L 4-S 1, and 1 case of L 3-S 1. The time from the initial fixation and fusion to this admission was 82.5±45.5 months (rang, 24 to 180 months). ASDis occurred at the proximal end of the fixed fusion segment in 28 cases and at the distal end in 3 cases. The types of ASDis: degenerative disc disease in 11 cases, lumbar spinal stenosis in 15 cases, degenerative spondylolisthesis in 2 cases, and degenerative scoliosis in 3 cases. The location of ASDis: 6 cases of L 2, 3, 12 cases of L 3, 4, 6 cases of L 4, 5, 3 cases of L 1-L 3, 1 case of L 2-L 4, and 3 cases of L 1-L 4. At admission, 3 cases of lumbar internal fixation had been removed and 28 cases of internal fixation remained. Stand-alone OLIF was performed in 19 cases, OLIF combined with pedicle screw fixation in 8 cases, and OLIF combined with cortical screw fixation in 4 cases. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the low back pain and lumbar function before operation and at the last follow-up, and the imaging results and complications were observed. Results:All patients were followed up. The follow-up time was 23.6±9.6 months (range, 12 to 60 months). The operation time was 73.8±25.3 mins (range, 40 to 180 min), and the intraoperative blood loss was 86.2±67.4 ml (range, 20 to 310 ml). The average blood loss in each segment was 24.8 ml. During the operation, there were 1 case of segmental vein injury, 7 cases of endplate injury, 2 cases of transient iliopsoas muscle weakness, 1 case of thigh pain and numbness, and 1 case of incomplete intestinal obstruction. There was no incision necrosis and infection. The VAS score of low back pain decreased from 5.9±1.9 before operation to 1.4±0.6 at the last follow-up, with a statistically significant difference ( t=8.47, P<0.001). The ODI index recovered from 45.2%±5.7% before operation to 13.8%±4.7% at the last follow-up, with a statistically significant difference ( t=7.92, P<0.001). The height of intervertebral space increased from 8.7±1.6 mm before operation to 11.4±1.9 mm after operation and 9.9±1.8 mm at the last follow-up. There was a statistically significant difference between postoperative and preoperative height of intervertebral space ( F=4.15, P=0.007). There was a statistically significant difference between the last follow-up and postoperative height of intervertebral space ( P=0.011). During the follow-up, there were 13 cases of fusion cage subsidence, 1 case of fusion cage displacement, and no case of internal fixation loosening or fracture. The intervertebral fusion rate was 94%(29/31) and the complication rate was 42%(13/31). Conclusion:ASDis is a common complication after lumbar fixation and fusion, and requires surgical treatment. OLIF is a reliable method to treat ASDis as it has advantages of small trauma, high fusion rate and low complication rate.

Thoracic aortic dissection (TAD) without familial clustering or syndromic features is known as sporadic TAD (STAD). So far, the genetic basis of STAD remains unknown. Whole exome sequencing was performed in 223 STAD patients and 414 healthy controls from the Chinese Han population (N = 637). After population structure and genetic relationship and ancestry analyses, we used the optimal sequence kernel association test to identify the candidate genes or variants of STAD. We found that COL3A1 was significantly relevant to STAD (P = 7.35 × 10
Aneurysm, Dissecting/genetics* ; Case-Control Studies ; Cluster Analysis ; Cohort Studies ; Collagen Type III/genetics* ; Computational Biology ; Genetic Predisposition to Disease ; Humans

BACKGROUND: As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches. METHODS: In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months' management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months. RESULTS: A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96. CONCLUSIONS: The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management. TRIAL REGISTRATION ClinicalTrials.gov, NCT03264638.
Biomarkers ; Female ; Humans ; Metabolomics ; Polycystic Ovary Syndrome/diagnosis* ; Prospective Studies ; ROC Curve

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

Objective:To compare the clinical outcomes and complications of oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach and posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel for lumbar spinal stenosis.Methods:A retrospective study was conducted on 73 patients who underwent surgical treatment for lumbar spinal stenosis from Jun 2015 to Jun 2017, including 33 males and 40 females. The average age was 66.8±7.94 years (from 39-85 years). These diseases occured at L 3/4 in 5 patients and L 4/5 in 68 patients. Random according to the time of admission, 38 cases were treated with oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach (oblique lateral fusion group), and 35 cases with posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel (posterior fusion group). The clinical results, image data and complications were compared between the two groups. Results:All patients in both groups had operation performed smoothly. The operation time was 99±8.96 min in the oblique lateral fusion group and 96.8±9.57 min in the posterior fusion group, and there was no significant difference between the two groups. The intraoperative bleeding in the oblique lateral fusion group 80±24.72 ml was significantly less than that in the posterior fusion group 261±52.87 ml ( t=9.621, P<0.05). No incision infection occurred after surgery. The VAS score of lumbar incision 72h after operation in the oblique lateral fusion group 1.21±0.55 was significantly less than that in the posterior fusion group 1.70±0.86 ( t=3.723, P=0.028). The follow-up period lasted for 12-24 months, averagely 17.5±2.58 months. There was statistically significant difference between preoperative and postoperative in the two groups, whether it was the area of the foraminal canal or the area of the spinal canal. There wboth the foraminal area and the spinal canal area were enlarged. The intervertebral space height in the two groups recovered significantly after surgery, the difference was statistically significant. But the intervertebral space height were partly lost at the last follow-up, and there was significant difference compared with postoperative. During the follow-up, no pedicle screw loosening, displacement, rupture, or anterior and lateral displacement of cage occurred. The fusion rate was 97.1% in the posterior fusion group and 100% in the oblique lateral fusion group. There was no statistical difference between the two groups.In terms of ODI index: the posterior fusion group recovered from 48.6±6.1 preoperative to 10.2±2.2 at the last follow-up, and the oblique lateral fusion group recovered from 49.0±5.7 preoperative to 9.3±1.8 at the last follow-up. There was statistically difference between last follow-up and preoperative in the two groups. The incidence of complications in the posterior fusion group was 22.86%, and the incidence in the oblique lateral fusion group was 23.68%. There was no significant difference between the two groups. Conclusion:Both the two decompression and fusion methods have achieved good clinical results in the treatment of lumbar spinal stenosis, with the advantages of less trauma, good stability, fast recovery, and high fusion rate. Compared with posterior decompression and fusion methods, the advantages of OLIF are more obvious, such as less bleeding,lower risk of nerve injury and good indirect decompression of spinal canal. Therefore, the OLIF technique can be a better choice for surgical treatment of lumbar spinal stenosis.

Objective:To investigate the characteristics and causes of endplate injury in the oblique lateral interbody fusion for the treatment of lumbar diseases, and summarize the precaution of endplate injury.Methods:Thirty-five cases of endplate injury were observed, which were originally treated with oblique lateral interbody fusion with or without pedicle screw fixation from October 2014 to December 2017. There were 7 males and 28 females, and the age ranged from 51 to 78 years old (averagely 62.8±8.13 years). There were 2 cases of lumbar disc degeneration, 10 cases of lumbar canal stenosis, 17 cases of lumbar degenerative spondylolisthesis, 2 cases of lumbar spondylolysis with or without spondylolisthesis, and 4 cases of lumbar degenerative scoliosis. Lesion sites contained L 3,4 in 2 cases, L 4,5 in 21 cases, L 2-4 in 3 cases, L 3-5 in 4 cases, L 2-5 in 3 cases and L 1-5 in 2 cases. Preoperative bone mineral density examination revealed there were 7 cases of T>-1 SD, 24 cases of -2.5 SD

Due to the influence of immunosuppression, nerve injury and other comprehensive factors, the overall incidence of gastrointestinal complications after lung transplantation is relatively high, which can cause drug absorption disorder and chronic rejection. In recent years, more and more studies have been conducted on these complications. However, due to the great difference of the incidence of gastrointestinal complications among lung transplantation centers, clinicians lack of understanding of these. In this article, the general status, common types and risk factors of gastrointestinal complications after lung transplantation were reviewed, aiming to provide reference for comprehensive management of gastrointestinal complications after lung transplantation.

Objective: To investigate the expression differences of serum tumor markers, such as CEA, CA125 and CA15-3, in different molecular subtypes of breast cancer and their correlations with recurrence and metastasis. Methods: The medical records and follow-up data from 212 patients with breast cancer were retrospectively analyzed. According to the expression of hormone receptor, breast cancer were divided into four molecular subtypes: Luminal A, Luminal B, Her-2 overexpression and Basal-like. The clinical characteristics and levels of CEA, CA125 and CA15-3 in different molecular subtypes of breast cancer patients before operation were compared, and the factors influencing the recurrence and metastasis of breast cancer were analyzed. Results: There were differences in the expression levels of tumor markers for different molecular subtypes of breast cancer. The expression levels of CA15-3 in patients with Her-2 overexpression were significantly higher than that with Luminal A, Luminal B or Basal-like (χ 2 =7.98,P=0. 04). The differentiation degree of tumor cells in different molecular subtypes of breast cancer was different, and the proportion of low differentiation in the patients with Her-2 overexpression was significantly higher than that with Luminal A, Luminal B or Basal-like (χ 2 =12.42,P=0.006). There was also differences in the recurrence and metastasis of tumor for 4 subtypes of breast cancer, and the highest recurrence and metastasis rate existed in the patients with Her-2 overexpression (F=8.69,P=0.034). The multivariate Cox regression analysis showed that tumor diameter, degree of tissue differentiation and presence or absence of vascular tumor thrombus were independent risk factors for the recurrence and metastasis of breast cancer patients (all P＜0.05). Conclusion The breast cancer patients with Her-2 overexpression have high levels of CA15-3 and poor prognosis, which suggests that the individualized treatment of breast cancer should be combined with molecular subtyping, tumor markers and related risk factors.

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.