Phacoemulsification with intraocular lens implantation(Phaco+lOL)has become the main treatment for cataracts due to small incision and fast recovery. Phacoemulsification can damage the conjunctiva, cornea and other ocular surface tissues, causing local inflammation, which in turn leads to eye dryness and discomfort after surgery. According to studies, patients who suffer from phacoemulsification most experience dry eye syndrome within 24 h, which gradually worsens and reaches its peak in the following 1 wk, seriously affecting their quality of life. The review aims to comprehensively investigate the effects of preoperative patient physical conditions and local ocular status, intraoperative maneuvers and postoperative treatments on postoperative dry eye, with the expectation of formulating scientific and effective preventive measures for potential dry eye patients after phacoemulsification, and providing a theoretical basis for postoperative dry eye treatment.

Background::Biliary tract carcinoma (BTC) is relatively rare and comprises a spectrum of invasive tumors arising from the biliary tree. The prognosis is extremely poor. The incidence of BTC is relatively high in Asian countries, and a high number of cases are diagnosed annually in China owing to the large population. Therefore, it is necessary to clarify the epidemiology and high-risk factors for BTC in China. The signs associated with BTC are complex, often require collaborative treatment from surgeons, endoscopists, oncologists, and radiation therapists. Thus, it is necessary to develop a comprehensive Chinese guideline for BTC.Methods::This clinical practice guideline (CPG) was developed following the process recommended by the World Health Organization. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of evidence and make recommendations. The full CPG report was reviewed by external guideline methodologists and clinicians with no direct involvement in the development of this CPG. Two guideline reporting checklists have been adhered to: Appraisal of Guidelines for Research and Evaluation (AGREE) and Reporting Items for practice Guidelines in Healthcare (RIGHT).Results::The guideline development group, which comprised 85 multidisciplinary clinical experts across China. After a controversies conference, 17 clinical questions concerning the prevention, diagnosis, and treatment of BTC were proposed. Additionally, detailed descriptions of the surgical principles, perioperative management, chemotherapy, immunotherapy, targeted therapy, radiotherapy, and endoscopic management were proposed.Conclusions::The guideline development group created a comprehensive Chinese guideline for the diagnosis and treatment of BTC, covering various aspects of epidemiology, diagnosis, and treatment. The 17 clinical questions have important reference value for the management of BTC.

AIM:To investigate the possible mech-anisms by observing the effects of sodium butyrate on the blood-brain barrier and cognitive function after intestinal ischemia/reperfusion in rats.METH-ODS:SD rats were randomly divided into 4 groups of 12 rats each,(1)sham-operated group(the Sham group);(2)intestinal ischemia/reperfusion group(the Ⅱ/R group);(3)intestinal ischemia/re-perfusion+sodium butyrate group(the NaB group):gavage of NaB 500 mg·kg-1·d-1 for 1 week before modeling;(4)intestinal ischemia/reperfusion+sodi-um butyrate+ITSA-1 group(the ITSA-1 group):NaB 500 mg·kg-1·d-1 gavage 1 week before modeling+IT-SA-1 0.5 mg/kg intraperitoneal injection in the first 5 d,3 d and 1 d.Intestinal mucosal injury was eval-uated by HE staining.Morris water maze test evalu-ated the cognitive function of rats.The microstruc-ture of the blood-brain barrier was observed by transmission electron microscope.The levels of in-flammatory cytokines IL-1β,IL-6,TNF-α,Claudin5,ZO-1,and MMP-9 in brain tissue were detected by ELISA.Western blotting detected Claudin5,ZO-1,CypA,and MMP-9 levels.RESULTS:Compared with the Sham group,Chiu's score in the Ⅱ/R group was increased(P<0.001).The swimming distance was increased(P<0.05),the proportion of the non-plat-form quadrant was increased(P<0.001),and the in-cubation period was prolonged(P<0.05).The micro-structure of the blood-brain barrier was changed under the transmission electron microscope.The inflammatory cytokines IL-1β,IL-6,and TNF-α were increased(P<0.001),the expressions of CypA and MMP-9 were increased(P<0.01),and the expres-sions of Claudin5 and ZO-1 were decreased(P<0.01,P<0.001).Compared with the Ⅱ/R group,neu-roinflammation,and blood-brain barrier damage were reduced,and cognitive function was im-proved in the Ⅱ/R+NaB group.The above injuries in group Ⅱ/R+NaB+ITSA-1 were similar to those in group Ⅱ/R.CONCLUSION:Sodium butyrate can ameliorate Ⅱ/R-induced neurocognitive dysfunction in rats by alleviating blood-brain barrier damage,possibly related to inhibiting the CypA/MMP-9 pathway.

AIM:To evaluate the effect of astaxanthin(AST)on cognitive function of intestinal ischemia/re-perfusion(I/R)injury in rats and the role of autophagy.METHODS:Eight-week-old SPF-grade male Sprague-Dawley(SD)rats were randomly divided into sham group,I/R group,AST group and AST+3-methyladenine(3-MA)group,with 12 animals in each group.The superior mesenteric artery(SMA)of the rats in sham group was only exposed without clamping.The SMA in other 3 groups was clamped for 90 min,and then the arterial clamp was released to restore blood supply and perform reperfusion,thus establishing the intestinal I/R model.The rats in AST group were intraperitoneally in-jected with AST(45 mg·kg-1·d-1)3 d before modeling,and those in AST+3-MA group were intraperitoneally injected with AST(45 mg·kg-1·d-1)+3-MA(1.5 mg·kg-1·d-1)3 d before modeling.Morris water maze was used to evaluate the cogni-tive function of rats 48 h after surgery.Hematoxylin-eosin(HE)staining was used to evaluate intestinal tissue damage.Nissl staining of the frontal cortex was used to evaluate neuronal damage.The levels of interleukin-6(IL-6),IL-1β and tu-mor necrosis factor-α(TNF-α)in the frontal cortex and hippocampus were measured by ELISA kits.The protein levels of beclin-1,microtubule-associated protein 1 light chain 3(LC3)and P62 in the frontal cortex and hippocampus were detected by Western blot.RESULTS:Compared with sham group,the swimming distance of rats in I/R group was increased,with prolonged latency,elevated Chiu's score and decreased number of neurons(P<0.01),while the levels of IL-6,IL-1β and TNF-α in the frontal cortex and hippocampus were increased(P<0.01).Beclin-1 expression and LC3-II/LC3-I ratio in the frontal cortex and hippocampus were increased(P<0.05 or P<0.01).Compared with I/R group,the swimming distance and latency of rats in AST group were shortened,with decreased Chiu's score,increased neuronal number(P<0.01),de-creased IL-6,IL-1β and TNF-α levels in the frontal cortex and hippocampus(P<0.01),and increased beclin-1 expres-sion and decreased of P62 expression in the frontal cortex and hippocampus(P<0.05 or P<0.01).Compared with AST group,the swimming distance of rats in AST+3-MA group was increased,with prolonged latency,elevated Chiu's score,decreased number of neurons(P<0.05),increased levels of IL-6,IL-1β and TNF-α in the frontal cortex and hippocam-pus,and decreased beclin-1 expression and LC3-II/LC3-I ratio and increased P62 expression in the frontal cortex and hip-pocampus(P<0.01).CONCLUSION:Astaxanthin alleviates intestinal I/R-induced cognitive impairment in rats by pro-moting autophagy and inhibiting neuroinflammation.

Purpose To investigate the abnormal brain development in fetuses with isolated mild to moderate ventriculomegaly(VM)during the second and third trimesters of pregnancy by using semi-quantitative fetal total maturation score(fTMS).Materials and Methods A retrospective analysis was performed on 45 normal fetuses and 78 abnormal fetuses who underwent fetal MRI in the General Hospital of Ningxia Medical University from January 2018 to October 2022.fTMS was used to score all images.Linear regression was used to assess the relationship between fTMS and gestational age between normal and abnormal fetuses and to analyze the differences between fetuses with isolated mild and moderate VM and controls.Results In the control group,fetal fTMS was significantly positively correlated with gestational age(r=0.939,P<0.05).The linear regression equation between fTMS(Y)and gestational age(X)was as follows:Y=-28.1+1.25X.In the mild and moderate isolated VM groups,fTMS was positively correlated with gestational age(r=0.945,0.906,P<0.05).The linear regression equations of fTMS(Y)and gestational age(X)were:Y=-28.46+1.24X,Y=-25.57+1.13X.The average fTMS of healthy fetus,mild VM and moderate VM were(10.55±4.25)points,(10.13+4.08)points and(9.22±3.77)points,respectively.There was no significant difference in fTMS between the 49 fetuses with mild isolated VM and the control group(t=1.651,P>0.05).There was significant difference in fTMS between the 29 fetuses with moderate isolated VM and the control group(t=2.306,P<0.05).Conclusion fTMS is suitable for routine clinical use and sensitive to differences in brain maturation between fetuses with isolated moderate VM and healthy controls.

Objective To analyze the evaluation value of the standard deviation of erythrocyte volume distribution width(RDW-SD),erythrocyte volume distribution width standard deviation and platelet ratio(RPR)and erythrocyte volume distribution width standard deviation and lymphocyte ratio(RLR)in the de-compensation stage of cirrhosis in primary biliary cholangitis(PBC).Methods The blood routine indexes of 68 patients with PBC admitted and treated in this hospital from January 2019 to June 2021 were retrospective-ly analyzed and divided into the compensation stage(n=36)and decompensation stage(n=32)according to the diagnostic standard.2 mL venous blood was extracted from the patient on an empty stomach in the early morning.The red blood cell(RBC),mean corpuscular volume(MCV),hemoglobin(Hb),hematocrit(HCT),mean erythrocyte hemoglobin content(MCHC),RDW-SD,white blood cell(WBC),neutrophil absolute value(N#),lymphocyte absolute value(L#),platelet count(PLT),mean platelet volume(MPV),platelet volume distribution width(PDW),etc.were detected.The platelet to lymphocyte ratio(PLR),RPR and RLR were calculated.The influencing factors of decompensation stage of PBC cirrhosis were analyzed by binary logistic regression,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic values of different indicators in the decompensation stage of PBC cirrhosis.Results There were statistically significant differences in age,RBC,Hb,HCT,RDW-SD,L #,PLT,RPR and RLR between the compensation group and decompensation group in PBC cirrhosis(P＜0.05).The binary logistic regression analysis showed that the age[odds ratios(OR)=1.087,95％confidence intervals(CI):1.015-1.165,P＜0.05],RDW-SD(OR=1.144,95％CI:1.030-1.270,P＜0.05)and RLR(OR=1.041,95％CI:1.007-1.075,P＜0.05)were the independent risk factors for progressing to the decompensation stage in the patients with PBC cirrhosis com-pensation stage.The ROC curve analysis showed that the areas under ROC curve(AUC)of RDW-SD,RPR and RLR for the diagnosis alone of decompensation stage of PBC cirrhosis were 0.726,0.778 and 0.798,re-spectively,and the differences were not statistically significant(P＞0.05).Conclusion Combined with the age factor,regular monitoring of RDW-SD,RPR and RLR levels has a high predictive value for the develop-ment of PBC cirrhosis compensation stage to decompensation stage.

Objective To observe the clinical efficacy of Redo-Bentall surgery in the reoperation of aortic root lesions.Methods A retrospective analysis was performed on 46 patients who underwent Redo-Bentall surgery for aortic root lesions in our department from June 2010 to April 2022.They were 35 males and 11 females,at a mean age of 43.37±12.79 years,in 4.96±6.76 years since the last operation.General clinical data in perioperative period and during follow-up were collected and analyzed.Kaplan-Meier survival analysis was used to compare the survival rates of each etiological group.Results There were 9 cases of central end otitis,12 cases of Behset's disease,and 25 cases of other causes.After operation,4 cases(8.70％)experienced cardiac arrest,4 cases(8.70％)renal failure,2 cases(4.35％)gastrointestinal bleeding,2 cases(4.35％)new third-degree atrioventricular block and 2 cases(4.35％)permanent pacemaker placement.In perioperative period,3 cases(6.52％)died in hospital.During a mean follow-up of 5.03±3.27 years after discharge,5 cases(11.63％)were lost to follow-up,1 case died(2.33％),1 case had lacunar infarction(2.33％),and no severe bleeding or embolism complications was observed in the rest patients.The long-term survival rate was significantly lower in the endocarditis group(62.3％)and the Behcet's disease group(70％)than the other etiological groups(80％,P＜0.05).Conclusion The application of Redo-Bentall in the reoperation of aortic root lesions is safe and effective,but the survival rate is quite lower in the patients with infective endocarditis and Behcet's disease.

Objective To evaluate the effect of remimazolam for general anesthesia on cellular im-mune function and quality of postoperative recovery in patients undergoing laparoscopic radical surgery for colorectal cancer.Methods Sixty patients undergoing laparoscopic radical surgery for colorectal cancer,36 males and 24 females,aged 18-80 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were en-rolled in this study.The patients were divided into remimazolam group(group R)and propofol group(group P)by using a random number,with 30 patients in each group.Induction of anesthesia was as follows:remimazolam at a dose of 0.2-0.3 mg/kg was intravenously infused(intravenous injection time>1 minute)in group R,propofol at a dose of 1.0-2.0 mg/kg was intravenously infused in group P,and sufen-tanil at a dose of 0.3-0.5 μg/kg and cisatracurium at a dose of 0.15-0.2 mg/kg were intravenously in-fused injected after the patients consciousness disappeared,that is the modified observer's assessment of alertness/sedation score of 1-2 in two groups to complete tracheal intubation.Anesthesia maintenance was as follows:remimazolam at a dose of 1.0-2.0 mg·kg-1·h-1 was intravenously infused in group R,propo-fol at a dose of 4.0-12.0 mg·kg-1·h-1 was intravenously infused in group P,remifentanil at a dose of 0.1-0.2 μg·kg-1·min-1 was intravenously infused in two groups,and intravenous cisatracurium was in-jected intermittently to maintain the BIS value at 40-60 intraoperatively.The two groups percentage of CD3+,CD4+,CD8+T lymphocytes,natural killer cell and CD4+/CD8+ratio were collected before induction of anesthesia,at immediately after the end of the surgery,and 24,72 hours after surgery.The HR,MAP,percutaneous oxygen saturation,and bispectral index were collected before induction of anesthesia,immedi-ately after endotracheal intubation,immediately after surgical incision,immediately after endotracheal extu-bation.The incidence of intraoperative adverse cardiovascular events and utilization rate of vasoactive drugs were collected.The quality of recovery-15(QoR-15)scores before induction of anesthesia,and 24,72 hours after surgery were recorded.The Riker and Ramsay scores at awakening,emergence time,tracheal ex-tubation time,duration of post-anesthesia care unit(PACU)stay,first postoperative expiration time,and postoperative length of hospital stay were recorded.And the incidence of nausea,vomiting and sleepiness in the postoperative period of 24 hours were collected.Results Compared with group P,group R had signifi-cantly higher NK,CD3+,and CD4+cells immediately after the end of the surgery and 24 hours after surgery(P<0.05),significantly faster HR and higher MAP immediately after the end of the surgery(P<0.05),significantly lower incidence of intraoperative hypotension,bradycardia and the utilization rate of vasoactive drugs(P<0.05),and significantly higher QoR-15 scores 24,72 hours after surgery(P<0.05).There were no significant differences in the Riker and Ramsay scores between the two groups.Conclusion Com-pared with propofol,general anesthesia with remimazolam has less impact on the perioperative cellular im-mune function in patients undergoing laparoscopic radical surgery for colorectal cancer,with lower incidence of intraoperative hypotension and bradycardia,and higher quality of postoperative recovery.

Peripheral nerve block is a kind of analgesia with few adverse reactions and high safety.It has been widely used in anesthesia and postoperative analgesia in various kinds of operations.The rebound pain after nerve block is gradually recognized.This article reviews the definition,mechanism of occurrence,and intervention measures of rebound pain after peripheral nerve block,aiming to enhance the clinical doctors'attention to rebound pain after peripheral nerve block,and provide reference for the comprehensive management of rebound pain after peripheral nerve block.

Objective:To evaluate the impact of lymph node dissection in radical surgery on the prognosis for patients with stage T2b gallbladder cancer.Methods:Forty-seven patients undergoing radical surgery for T2b gallbladder cancer at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2009 to May 2020 were retrospectively analyzed, including 17 males and 30 females, aged 68(58, 72) years old. According to the extent of lymph node dissection, patients were divided into the regional lymph node dissection group ( n=28) and extended lymph node dissection group ( n=19). Clinical data including the level of carbohydrate antigen 19-9 (CA19-9), fashions of liver parenchymal resection, and postoperative complications were recorded. Survival follow-up was conducted through telephone or outpatient review. Survival analysis was conducted using Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was used to identify the risk factors of overall survival. Results:Compared to regional lymph node dissection, the extended lymph node dissection group had a longer operative time [195(167, 220) min vs. 165(152, 175) min] and a greater number of lymph nodes dissected [12(9, 14) vs. 8(7, 9)] (both P<0.05). The postoperative complication rates of the two groups were 14.3%(4/28) and 21.1%(4/19), respectively ( P=0.697). The cumulative postoperative 1-, 3-, and 5-year survival rates were 96.4%, 59.4%, and 52.8% in regional lymph node dissection group, and 84.2%, 62.7%, and 43.0% in extended lymph node dissection group, respectively, with no significant difference ( P=0.643). Multivariate Cox regression analysis indicated that CA19-9>40 IU/ml ( HR=2.98, 95% CI: 1.24-7.18, P=0.014), wedge resection of the liver ( HR=4.01, 95% CI: 1.36-11.87, P=0.011), and positive lymph node ( HR=2.99, 95% CI: 1.22-7.34, P=0.016) were independent risk factors for poor prognosis in patients with stage T2b gallbladder cancer. Conclusion:Compared with regional lymphadenectomy, extended lymphadenectomy does not improve the overall survival of patients with stage T2b gallbladder cancer.