AIM: To investigate the influence of pterygium thickness and area on corneal refractive status.METHODS: Prospective longitudinal study. A total of 60 cases(60 eyes)of pterygium patients admitted to our hospital from January 2024 to September 2024 were randomly selected. All patients underwent pterygium excision combined with pedicle conjunctival flap transplantation for treatment. Optical coherence tomography(OCT)was used to measure the preoperative thickness of patient's pterygium, and a digital slit lamp microscope was used to measure the area of pterygium. The corneal refractive status(degree of corneal astigmatism and average curvature)and changes in uncorrected visual acuity of patients before surgery, 1 d, 1, and 3 mo after surgery were compared. The relationship between preoperative thickness and area of pterygium in patients and corneal refractive status indicators at different postoperative time points were analyzed, and Logistic regression was used to analyze the impact of pterygium thickness and area on postoperative visual improvement in patients.RESULTS: All patients completed follow-up after surgery for 3 mo. At 3 mo after surgery, visual acuity improved in 21 eyes(35%). The results of bivariate Pearson correlation analysis showed that the thickness and area of pterygium positively correlated with the degree of corneal astigmatism and uncorrected visual acuity before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05), and negatively correlated with the average corneal curvature before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05). Logistic regression analysis showed that the thickness and area of pterygium before surgery, high degree of corneal astigmatism, and low uncorrected visual acuity(large LogMAR value)were all risk factors for poor postoperative visual improvement in patients(OR>1, P<0.05). The large average corneal curvature before surgery was a protective factor for poor postoperative visual improvement in patients(OR<1, P<0.05).CONCLUSION: The increase in thickness and area of pterygium can, to some extent, improve corneal astigmatism, reduce the average curvature of the cornea, and affect postoperative visual recovery.

BackgroundAnxiety exhibits a rising prevalence among college students. Investigating the mechanisms through which family function relates to anxiety and examining the moderating role of emotion regulation strategies within this context hold substantial implications for promoting mental health among college students. However， existing research has not sufficiently elucidated the complex interplay among family function， emotion regulation， and anxiety among college students. Further research is warranted to clarify the underlying mechanisms linking family function to anxiety outcomes and to examine the potential moderating role of emotion regulation strategies in this causal pathway. ObjectiveTo explore the relationship between family function and anxiety among lower-grade college students， and to validate the moderating role of emotion regulation strategies in this relationship， thereby offering evidence-based insights for anxiety reduction interventions in this population. MethodsIn March 2023， a total of 1 980 first- and second-year students from a comprehensive university in Shanghai were selected using the cluster sampling method. A self-designed demographic questionnaire， the Emotion Regulation Questionnaire （ERQ）， the Family Adaptability and Cohesion Evaluation Scale Ⅱ-Chinese Version （FACES Ⅱ-CV）， and the Symptom Checklist-90 （SCL-90） were utilized for assessment. Pearson correlation analysis and Spearman correlation analysis were employed to test the correlations of each variable. Hierarchical linear regression analysis was conducted to certify the moderating role of emotion regulation strategies in the relationship between family function and anxiety. ResultsCompared with female students， male students scored significantly lower on ERQ cognitive reappraisal （t=-5.793， P<0.01） but significantly higher on ERQ expressive suppression （t=8.359， P<0.01）. For lower-grade college students， scores on adaptability and cohesion subscales of FACES Ⅱ-CV showed a positive association with cognitive reappraisal in ERQ （r=0.251， 0.302， P<0.01）， while simultaneously displaying negative correlations with both expressive suppression in ERQ （r=-0.113， -0.154， P<0.01） and anxiety in SCL-90 （r=-0.243， -0.202， P<0.01）. Notably， anxiety scores in SCL-90 were inversely related to cognitive reappraisal scores in ERQ （r=-0.159， P<0.01） but directly associated with expressive suppression scores in ERQ （r=0.171， P<0.01）. Hierarchical regression analysis indicated that cognitive reappraisal significantly moderated the relationship between family cohesion and anxiety （β=-0.421， P<0.01）. ConclusionThe cognitive reappraisal strategy serves as a moderator in the relationship between family cohesion and anxiety， potentially mitigating the escalation of anxiety levels associated with family dysfunction. ［Funded by Science and Technology Development Fund of Shanghai Pudong New Area （number， PKJ2023-Y21）］

Minimally conscious state （MCS） is at the edge between closed and open consciousness， but it still belongs to the category of "wind-strike block" syndrome. The basic pathogenesis of MCS is the obstruction of pathogenic qi， orifices closed and spirit hidden， with pathological factors including phlegm， fire， and blood stasis. Wind movement and water retention may also be present， and often leading to deficiency syndrome due to the exhaustion of qi， blood， yin， and yang at later stages. Treatment chooses Shexiang （Moschus） as the chief medicinal， emphasizing combination of medicinals and urgency of medication administration； the key therapeutic method is to open the orifices， with focuses on expelling pathogens and reinforcing healthy qi. For patients with severe phlegm or fire， use Xiaochengqi Decoction （小承气汤） to open the lower orifices， discharge heat and unblock the bowels， combined with Shexiang （Moschus） and Niuhuang （Bovis Calculus） to open the upper orifices， awaken the spirit and guide qi. For patients with turbid phlegm as the predominant， temporarily replace Shexiang （Moschus） with Baizhi （Angelicae dahuricae radix）， using Ditan Decoction （涤痰汤） to eliminate phlegm to open the orifices， when turbid phlegm gradually subsided， Shexiang （Moschus） could be added. For patients with blood stasis as the predominant， Tongqiao Huoxue Decoction （通窍活血汤） will be used to activate blood and open orifice， if the blood circulates， the endogenous wind will be calmed， the water will be induced， the orifices will open and the consciousness will restore. For patients with closed orifices and body deficiency， the treatment should open the orifices and reinforce healthy qi， and consider the root and branch simultaneously； qi deficiency syndrome can be addressed with Buyang Huanwu Decoction （补阳还五汤） to boost qi and reinforce healthy qi； yin deficiency syndrome can be treated with Shaoyao Gancao Decoction （芍药甘草汤） combined with Fengsui Pill （封髓丹） to nourish yin， soften sinews， and secure kidney essence； yang deficiency can be managed by using Dihuang Yinzi Decoction （地黄饮子） to enrich yin， supplement yang， and open the orifices.

Hepatic osteodystrophy is a common complication in patients with chronic liver disease and is influenced by various risk factors， and it has become one of the important influencing factors for the prognosis of liver transplantation. By analyzing the influencing factors for bone health and bone metabolism during the perioperative period of liver transplantation， this article emphasizes the importance of a comprehensive assessment of bone health and necessary interventions at this stage， with an aim to reduce the risk of postoperative complications and improve the long-term prognosis of patients. A deeper exploration of the association between hepatic osteodystrophy and the prognosis of liver transplantation can help to reveal the key influencing factors for postoperative outcomes， thus providing a theoretical basis for optimizing postoperative management strategies. Furthermore， advances in this research field will offer new insights into the treatment of patients receiving liver transplantation， and it is expected to further improve quality of life and long-term survival rate.

Depressed mood and sleep problems are prevalent among elderly people and tend to form a vicious cycle that seriously affects their quality of life and physical health. However， most of the existing studies rely on cross-sectional design， limiting the ability to clarify their predictive relationship and causal direction. ObjectiveTo explore the longitudinal association between nighttime sleep duration and depressed mood among the elderly in China over a 10-year period， providing scientific evidence for developing sleep-related interventions and depression prevention strategies tailored to the elderly. MethodsBased on nationally representative data from the China Health and Retirement Longitudinal Study （CHARLS） between 2011 and 2020， a sample of 5 954 elderly peolpe who had completed the baseline survey and at least one follow-up survey in 2011 was selected. Depressed mood was assessed using the 10-item Centre for Epidemiological Studies Depression Scale （CESD-10）. Basic information including nighttime sleep duration， was collected through a self-designed questionnaire. Cross-lagged path analysis （CLPA） model was employed to analyze the bidirectional relationship between nighttime sleep duration and depressed mood among the ederly. ResultsThe nighttime sleep duration in elderly people showed a negative correlation with CESD-10 scores at both baseline and the last follow-up （r=-0.299， -0.247， P<0.01）. The results of the CLPA model showed that the baseline CESD-10 scores negatively predicted nighttime sleep duration at the last follow-up （β=-0.100， P<0.01）， while baseline nighttime sleep duration also predicted CESD-10 scores at the last follow-up （β=-0.041， P<0.01）. ConclusionDepressed mood in elderly people exhibits a longitudinal association with nighttime sleep duration， demonstrating a bidirectional negative predictive relationship between the two factors.

Objective:To investigate the expression of protein kinase D2(PRKD2)in bladder cancer(BLCA)tissue using bioinformatics analysis method and its effect on the prognosis of BLCA patients,and to clarify the role of PRKD2 in the occurrence and development of BLCA.Methods:The data from 9 normal bladder samples,19 BLCA paracancerous samples,and 407 BLCA tumor samples were downloaded from the UCSC Cancer Genome Database.The Mann-Whitney U test was applied to analyze the difference in expression of PRKD2 mRNA in BLCA tumor and normal bladder tissues,and the Human Protein Atlas(HPA)database was used for proteomic validation.DESeq2 package in R software was applied to screen the differentially expressed genes(DEGs)in BLCA tissue in PRKD2 low-and high-expression groups.The co-expression heatmaps of PRKD2 were plotted using the ggplot2 package,Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)were used for functional annotation analysis and pathway enrichment analysis of DEGs,and Gene Set Enrichment Analysis(GSEA)was used to obtain the gene sets that were significantly enriched for DEGs.The BLCA samples were divided into low-and high-expression groups according to the expression level of PRKD2,and the correlations between PRKD2 expression and immune cell infiltration in the BLCA patients were analyzed with GSVA package.The relationship between PRKD2 and prognosis of BLCA patients was further analyzed using the survival package and the survminer package.The PRKD2 gene mutations in BLCA tissue were analyzed using the cBioPortal database.The cystitis,bladder polyp and BLCA tissues were collected,and the expression levels of interleukin-17F(IL-17F)protein in BLCA and control tissues were detected using immunohistochemical staining technique.Results:PRKD2 was highly expressed in a variety of malignant tumors,and the expression levels of PRKD2 mRNA and protein in BLCA tissue were significantly increased compared with those in normal bladder tissue(P＜0.05).Single gene differential analysis of PRKD2 yielded a total of 1 058 DEGs,of which a total of 29 genes were up-regulated and 1 029 were down-regulated.The results of GO functional enrichment analysis showed that DEGs were mainly enriched in the biological process(BP),such as chemical stimuli involved in sensory perception,Cajal body,and endopeptidase inhibitor activity.The results of KEGG pathway analysis showed that DEGs were mainly enriched in the pathway of Staphylococcus aureus infection and the pathway of maturity onset diabetes of the young.GSEA analysis showed that DEGs were mainly enriched in the Notch signaling pathway,the retinoic acid-inducible gene-Ⅰ(RIG-Ⅰ)-like receptor signaling pathway,the cytoplasmic DNA screening pathway,the base excision repair signaling pathway,natural killer(NK)cell-mediated cytotoxicity signaling pathway and T cell receptor signaling pathway.The results of immune infiltration analysis indicated that the expression of PRKD2 was positively correlated with five types of cells,such as activated dendritic cells(aDC),NK CD56dim cells and central memory T cells(Tcm)(P＜0.05),and negatively correlated with three types of immune cells,including macrophages,effector memory T cells(Tem)and plasmacytoid dendritic cells(pDC)(P＜0.05).The clinical characteristic subgroup analysis results showed that the expression levels of PRKD2 mRNA in BLCA patients who were over 70 years old and developed lymphovascular invasion were decreased(P＜0.05);the overall survival(OS),disease-specific survival(DSS)and progression-free interval(PFI)in the BLCA patients with PRKD2 high expression were significantly longer than those with PRKD2 low expression(P＜0.05).The univariate and multivariate Cox analyses indicated that distant metastasis,primary therapy outcome and clinicopathologic stage were the important factors affecting BLCA prognosis.About 9％patients had PRKD2 gene mutations,including missense mutation,gene amplification,mRNA low or high expression,and multi-motif mutation.The immunohistochemistry results showed that the expression level of IL-17F protein in BLCA tissue was significantly higher than that in cystitis tissue(P＜0.05).Conclusion:The expression level of PRKD2 in BLCA tissue is obviously increased,which could up-regulate the expression of IL-17F protein,and the decrease of PRKD2 protein expression may be a potential factor for the poor prognosis of BLCA patients.

The epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutation is a rare subtype of mutations in non-small cell lung cancer (NSCLC). Patients with advanced NSCLC carrying the EGFR ex20ins mutation tend to have poor responses to traditional EGFR tyrosine kinase inhibitors (TKIs), chemotherapy, and immunotherapy, leading to a poor clinical prognosis. Significant progress has been made in the development of new drugs targeting the EGFR ex20ins mutation. The research on new drugs targeting EGFR ex20ins mutations has made significant progress. The main ones include new EGFR-TKIs (such as sunvozertinib, mobocertinib, and furmetinib, etc.), bispecific antibodies (such as amivantamab, JMT101, and GB263T, etc.), and emerging drugs such as AUY922. These agents have demonstrated promising efficacy in clinical trials, improving the objective response rate and progression-free survival of patients, and are expected to improve overall survival. An in-depth analysis of the mechanism of action and clinical trial progress of these novel targeted drugs for EGFR ex20ins-mutated NSCLC can offer new therapeutic strategies for patients with EGFR ex20ins-mutated NSCLC.

Objective To compare the efficacy and safety of stellate ganglion block(SGB)with those of conventional western medication in the treatment of insomnia.Methods A computerized retrieval of academic papers concerning the clinical randomized controlled trials of SGB versus conventional western medication in the treatment of insomnia from the databases of PubMed,Embase,Cochrane Library,CNKI,Wanfang Data knowledge service platform,VIP database and CBM database was conducted.The retrieval time period was from the establishment of the database to June 13,2023.NoteExpress v3.5 software was used to make literature screening,Stata17.0 software was used to perform meta-analysis of the obtained data,TSA0.9.5.10 beta software was used to make sequential analysis,and GRADEpro was used to perform the grade classification.Results A total of 11 articles including 875 patients with insomnia were included in this analysis.Compared with the conventional western medication,SGB showed certain advantages in the following aspects:improving total clinical effectiveness(RR total=1.24,95％CI:1.16-1.32,P＜0.01),increasing the proportion of patients who could sleep for more than 3 hours after treatment(RR total=1.24,95％CI:1.09-1.41,P=0.001),increasing total sleep time(SMD=1.53,95％CI:0.89-2.16,P＜0.01),reducing sleep latency(MD=-14.08,95％CI:-18.72--9.43,P＜0.01),decreasing PSQI score(MD=-3.54,95％CI:-4.31--2.78,P＜0.01),and reducing the recurrence rate within 6 months(RR=0.19,95％CI:0.10-0.37,P＜0.01).However,the difference in the proportion of patients who could sleep for more than 6 hours after treatment between the two groups was not statistically significant(RR=1.31,95％CI:0.97-1.76,P=0.078).The traditional SGB therapy had a certain risk of adverse events,ultrasound-guided SGB therapy was much safer.Trial sequential analysis showed that the cumulative sample size of the effective rate crossed the conventional threshold and TSA threshold,the positive results had been obtained in advance although it did not reach RIS.The quality of evidence evaluated by GRADE for the sleep latency,PSQI and recurrence rate within 6 months was medium grade,and the quality for the remaining indexes was low grade.Conclusion Compared with conventional western medication for the treatment of insomnia,the effect of SGB in increasing the total response rate,the proportion of patients who get sleeping for more than 3 hours after treatment and the total sleep duration,in reducing sleep latency,PSQI score and recurrence rate within 6 months has gained some certain evidence supports.The SGB and conventional western medication have similar efficacy in improving the proportion of patients who get sleeping for more than 6 hours after treatment.The results of this study are stable and reliable,but the current level of evidence grade is lower,therefore,large-sample randomized controlled trials need to be conducted before its clinical efficacy can get further evidence-based support.

Objective To investigate the effect of progressive muscle relaxation training intervention strategy in relieving fatigue of elderly patients with primary hepatocellular carcinoma(HCC)after receiving transcatheter arterial chemoembolization(T ACE),and to analyze its influencing factors.Methods Using convenience sampling method,a total of 150 elderly patients with HCC,who received TACE at a certain grade Ⅲ-A hospital at Peking of China from May 2021 to March 2023,were selected as the subjects of research.The patients were randomly divided into the study group and the control group,and progressive muscle relaxation training intervention strategy and conventional postoperative fatigue care method were employed respectively.The preoperative fatigue status and the postoperative fatigue recovery status were compared between the two groups,and the influencing factors were analyzed.Results In both groups,the postoperative one-day fatigue score was the highest,which was gradually decreased thereafter.The average recovery time of fatigue in the control group was 9.84 days,which in the study group was 6.16 days,the difference between the two groups was statistically significant(P=0.013).The body mass index(BMI),Child-Pugh classification,and preoperative grip strength index had an effect on the postoperative fatigue recovery time after intervention.A BMI of β=-0.953 and a preoperative grip strength index of β=-0.185 were negatively correlated with the postoperative fatigue recovery time after intervention,while a Child-Pugh classification of β=2.177 was positively correlated with the postoperative fatigue recovery time after intervention.Conclusion Progressive muscle relaxation training intervention strategy is helpful for shortening the postoperative fatigue recovery time in elderly patients with HCC after receiving TACE,and it is worth of promotion in clinical practice.The patient's nutrition and physical status such as BMI,hepatic reserve function and grip strength index,are the factors influencing the effectiveness of progressive muscle relaxation training intervention strategy.

Objective To investigate the relationships of CXC motif chemokine ligand 10(CXCL10)and CC motif chemokine ligand 11(CCL11)in the peripheral blood with type 2 diabetic osteoporosis(T2DOP),and to construct a predictive model.Methods A total of 260 patients with type 2 diabetes mellitus(T2DM)were prospectively selected as the T2DM group.They were divided into T2DOP group(n=82)and non-T2DOP group(n=178)according to the occurrence of T2DOP.Additionally,68 healthy volunteers with physical examinations in the same period were se-lected as control group.Enzyme-linked immunosorbent assay was used to detect the levels of CXCL10 and CCL11 in the peripheral blood as well as bone metabolism indicators[β-C-terminal te-lopeptide of type Ⅰ collagen(β-CTX),N-terminal propeptide of type Ⅰ procollagen(PⅠNP)].Pear-son correlation analysis was used to explore the correlation of CXCL10 and CCL11 in peripheral blood with bone metabolism indicator levels in patients with T2DM.Multifactor non-conditional Logistic regression analysis was used to explore the influencing factors of T2DOP and construct a pre-dictive model.The Hosmer-Lemeshow(H-L)test was used to assess the goodness of fit.The re-ceiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of each indicator and the predictive model for T2DOP,and decision curve analysis and Bootstrap resa-mpling were used for internal validation.Results Compared with the control group,the levels of CXCL10 and CCL11 in the peripheral blood as well as β-CTX in the T2DM group were significantly increased,while the level of P Ⅰ NP was significantly decreased(P＜0.05).Pearson correlation a-nalysis showed that CXCL10 and CCL11 in the peripheral blood in patients with T2DM were posi-tively correlated with β-CTX level(r=0.786,0.816,P＜0.001)and negatively correlated with P ⅠNP level(r=-0.675,-0.716,P＜0.001).Compared with the non-T2DOP group,the T2DOP group had significantly increased age and the ratio of diabetic nephropathy,prolonged dura-tion of diabetes,decreased body mass index(BMI)and P ⅠNP levels,and increased fasting blood glucose,glycated hemoglobin(HbA1c),β-CTX,CXCL10,and CCL11 levels(P＜0.05).Non-conditional Logistic regression analysis showed that advanced age,long duration of diabetes,high HbA1c,high CXCL10,and high CCL11 were independent risk factors for T2DOP(P＜0.05),while high BMI was an independent protective factor(P＜0.05).The ROC curve showed that the area under the curve(AUC)of the predictive model for predicting T2DOP was 0.919,which was significantly greater than the AUCs of 0.643,0.742,0.654,0.715,0.759 and 0.741 respectively for age,duration of diabetes,BMI,HbA1c,CXCL10 and CCL11 alone(Z=7.468,5.400,7.415,6.365,5.242,5.800,P＜0.001).After internal validation,the decision curve of the predictive model was higher than the two extreme curves.After 1,000 times of Bootstrap resampling internal validations,the concordance index of the predictive model was 0.919(95％CI,0.914 to 0.923).Conclusion Increased levels of CXCL10 and CCL11 in the peripheral blood are associat-ed with T2DOP,and the predictive model constructed based on these factors has a high predictive value for T2DOP.