In recent years, the prevalence of myopia has continued to rise, with an expanding affected population, making it a significant public health challenge both in China and globally. Elongation of the axial length in myopic eyes can induce a series of pathological changes in intraocular structure and function, increasing the risk of blinding ocular diseases such as retinal pathologies. Since myopia is difficult to reverse once established, scientific intervention is necessary to control its progression and reduce the likelihood of ocular complications. As a current research focus in myopia control, the clinical application of orthokeratology lenses has attracted considerable attention. This article highlights that orthokeratology lenses, worn overnight, reshape the corneal curvature and create a myopic defocus signal in the peripheral retina. This mechanism effectively inhibits excessive axial elongation and slows myopia progression. Clinical evidence indicates that orthokeratology can reduce axial elongation by 30% to 50%, accompanied by a short-term increase in choroidal thickness. This article also analyzes the advantages and limitations of orthokeratology and explores its potential synergistic effects when combined with other interventions such as low-dose atropine. The aim is to provide key theoretical and practical references for clinical myopia control.

Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.

ObjectiveTo analyze the factors influencing meropenem-related liver injury （MRLI） and to explore their clinical predictive value. MethodsA retrospective case-control study was conducted， and the Chinese Hospital Pharmacovigilance System （CHPS） was used to establish a retrieval scheme. A total of 1 625 hospitalized cases using meropenem from January 2018 to December 2022 were collected. Patients were divided into case group （n=62） and control group （n=1 563） based on the presence or absence of liver injury. Clinical data and laboratory indicators from both groups were collected and analyzed. The t-test was used for comparison of normally distributed continuous data between the two groups， while the Mann-Whitney U test was used for comparison of continuous data not conforming to a normal distribution. The chi-square test was used for comparison of categorical data between the two groups. A multivariate Logistic regression analysis was performed to identify the influencing factors for MRLI. A Logistic regression equation was established， and the predictive value of these factors was assessed using the receiver operating characteristic （ROC） curve. ResultsThe results of univariate analysis indicated that the rates of male patients， hypoproteinemia， shock， intensive care unit （ICU） admissions， sepsis， and liver， gallbladder， and cardiovascular diseases， the levels of alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， aspartate aminotransferase （AST）， creatinine （CREA）， and procalcitonin （PCT）， and the number of hospitalization days were significantly higher in the case group than in the control group （P<0.05）， and that the platelet levels in the case group were significantly lower than those in the control group （P<0.05）. The multivariate Logistic regression analysis showed that male sex （odds ratio ［OR］=2.080， 95% confidence interval ［CI］： 1.050 — 4.123， P=0.036）， admission to the ICU （OR=8.207， 95%CI： 4.094‍ ‍—‍ ‍16.453， P<0.001）， comorbidity with gallbladder disease （OR=8.240， 95%CI： 3.605‍ ‍—‍ ‍18.832， P<0.001）， ALP （OR=1.012， 95%CI： 1.004‍ ‍—‍ ‍1.019， P=0.004）， GGT （OR=1.010， 95%CI： 1.005‍ ‍—‍ ‍1.015， P<0.001）， and PLT （OR=0.997， 95%CI： 0.994‍ ‍—‍ ‍0.999， P=0.020） were the influential factors for MRLI. The areas under the ROC curve of ALP， GGT， and PLT were 0.589， 0.637， and 0.595， respectively， and the AUC of them combined was 0.837. ConclusionMale sex， ICU admission， comorbidity with gallbladder disease， increased ALP， increased GGT， and decreased PLT were influencing factors for MRLI， and a combination of factors has a better predictive value for the occurrence of MRLI.

ObjectiveTo investigate the neuroprotective effects of Tiaoseng decoction on a perimenopausal depression （PMD） rat model and to examine its regulatory influence on the estrogen receptor β （ERβ）/monoamine oxidase A （MAOA）/c-Jun N-terminal kinase （JNK） signaling pathway， thereby elucidating its potential mechanisms of action. MethodsForty-eight female Sprague-Dawley （SD） rats were divided into a sham group， a model group， a 17β-estradiol （E₂） group （2.5 × 10^-5 g·kg^-1）， and low-， medium-， and high-dose Tiaoseng decoction groups （9.69， 19.37， 38.74 g·kg^-1） by using a random number table method， with eight rats in each group. The PMD model was replicated using ovariectomy （OVX） combined with chronic unpredictable mild stress （CUMS） and was treated continuously with 17β-E₂ and different doses of Tiaoseng decoction for 28 d， once a day. Depressive-like behaviors were assessed using the sucrose preference test， open-field test， and forced swim test. Histopathological changes in the prefrontal cortex were examined using hematoxylin-eosin （HE） and Nissl staining. Enzyme-linked immunosorbent assay （ELISA） was performed to measure serum levels of E₂， luteinizing hormone （LH）， and follicle-stimulating hormone （FSH）， as well as reactive oxygen species （ROS）， malondialdehyde （MDA）， and superoxide dismutase （SOD） levels in the prefrontal cortex. Mitochondrial ultrastructure of prefrontal cortex neurons was observed via transmission electron microscopy. Terminal deoxynucleotidyl transferase dUTP nick-end labeling （TUNEL） was used to detect neuronal apoptosis in the prefrontal cortex. Immunohistochemistry （IHC） was applied to analyze the protein expression of brain-derived neurotrophic factor （BDNF）， postsynaptic density protein95 （PSD95）， and synaptophysin （SYP） in the prefrontal cortex. Immunofluorescence （IF） was conducted to evaluate the average fluorescence intensity of ERβ and MAOA in the prefrontal cortex. Western blot and real-time quantitative polymerase chain reaction （Real-time PCR） were used to determine the protein and mRNA expression levels of key molecules in the ERβ/MAOA/JNK signaling pathway in the prefrontal cortex. ResultsCompared with the sham group， the model group had significantly reduced sugar-water preference index， total distance traveled， average speed， and activity time in the central region in the open field experiment， E₂ content， and SOD content （P<0.01） and significantly reduced BDNF， PSD95， SYP， and ERβ expression and B-cell lymphoma-2 （Bcl-2）/Bcl-2-associated X protein （Bax） ratio （P<0.01）. Additionally， the model group exhibited severe histopathological damage， disrupted mitochondrial structure， cristae disappearance or fracture， swelling， and deformation in the prefrontal lobe. The immobilization time of forced swimming， TUNEL positivity， LH， FSH， MDA， ROS， MAOA， Caspase-3， p-JNK/JNK， and p-c-Jun/c-Jun were significantly increased in the model group compared with the sham group （P<0.01）. Compared with the model group， the low-， medium-， and high-dose Tiaoseng decoction groups and the 17β-E₂ group had increased sugar-water preference index， total distance traveled， average speed， and activity time in the central region in the open-field test， E₂ content， and SOD content （P<0.05， P<0.01） and elevated BDNF， PSD95， SYP， and ERβ expression and Bcl-2/Bax ratio （P<0.05， P<0.01）. In addition， histopathological damage to the prefrontal lobe was improved to different degrees， and mitochondrial structure was gradually repaired. The immobilization time of forced swimming， TUNEL positivity， LH， FSH， MDA， ROS， MAOA， Caspase-3， p-JNK/JNK and p-c-Jun/c-Jun were significantly reduced in the low-， medium-， and high-dose Tiaoseng decoction groups and the 17β-E₂ group compared with the model group （P<0.05， P<0.01）. ConclusionTiaoseng decoction has significant neuroprotective effects on PMD model rats， which can alleviate perimenopausal depressive disorder by inhibiting oxidative stress， attenuating neuronal apoptosis， and restore synaptic plasticity via ERβ/MAOA/JNK signaling pathway regulation.

Objective: To explore the relationship between sleep characteristics, physical activity patterns, with depressive and anxiety symptoms in college students, so as to provide reference for student mental health promotion. Methods: From September to November 2023, a convenience sampling method was used to select 7 954 college students aged 18-22 years from 9 universities in Shanghai, Hubei, and Jiangxi. Assessments were conducted using the International Physical Activity Questionnaire Short-Form (IPAQ-SF), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Pittsburgh Sleep Quality Index (PSQI) to evaluate physical activity, depressive and anxiety symptoms, and sleep quality, respectively. Logistic regression analysis was employed to explore the impact of sleep characteristics and physical activity patterns on depressive and anxiety symptoms and their comorbidity among college students. Results: The detection rates for depressive symptoms, anxiety symptoms, and comorbid depression and anxiety symptoms were 25.67%, 35.39%, and 23.15%, respectively. Factors such as gender, grade, household registration, parental education level, annual family income, family structure, and dietary habits were all associated with the detection rates of depressive and anxiety symptoms and their comorbidity (χ2=4.41-118.39, P<0.05). Physical activity patterns, sleep duration, sleep quality, and sleepwake characteristics were also associated with the occurrence of depressive and anxiety symptoms and their comorbidity (χ2=9.66-627.70, P<0.05). Logistic regression analysis showed that college students who stayed up late and slept less than 7 had the highest risk of depressive and anxiety symptoms and their comorbidity (OR=1.93, 1.85, 1.88, P<0.05). Compared to regular physical activity patterns, insufficient physical activity patterns were associated with an increased risk of depressive and anxiety symptoms (all OR=1.18, P<0.05). Further stratified analysis results showed that the risk of depression, anxiety and their comorbidity increased in college students who stayed up late and slept less than 7 h, went to bed before midnight and slept less than 7 h, or went to bed before midnight and slept more than 7 h but did not have sufficient physical activity (P<0.05). Conclusions Sleep characteristics and physical activity patterns significantly affect depressive and anxiety symptoms in college students. Universities should strengthen sleep management and implement flexible physical activity interventions to help students establish healthy lifestyles.

In recent years, the incidence of myopia has been increasing alongside the growing global population, emerging as a significant public health challenge worldwide. Individuals with myopia exhibit an elongated axial length, which leads to various structural and functional ocular changes, resulting in the risk of related eye diseases and, in severe cases, blindness. Unfortunately, once myopia develops, it is irreversible. The only way to prevent or slow its progression is through appropriate treatment. The current focal point in myopia prevention and control is the peripheral myopic defocus theory. This paper summarizes the relevant research on defocus incorporated multiple segments(DIMS)lenses, following a systematic analysis of the literature. It analyzes the advantages and disadvantages of DIMS compared to other myopia control methods, and discusses the application prospects and future directions of defocus lenses represented by DIMS, aiming to provide reference and guidance for the control of myopia progression in children and adolescents.

Objective To investigate the current situation of career growth of public hospital managers and analyse its influencing factors,in order to provide a reference basis for promoting the level of career growth of hospital managers.Methods A convenient sampling method was applied to select 276 managers from nine public secondary and tertiary public hospitals in Hubei Province as the respondents,and a General Information Questionnaire,Career Growth Scale,and Person-organisation Fit scale were used to conduct the survey.Descriptive statistics,ANOVA,Pearson correlation analysis,and multiple linear regression were used to complete the analysis of the current status of career growth and influencing factors.Results The overall score of hospital managers'career growth is 3.29±0.79;person-organisation fit scores were positively correlated with hospital managers'career growth scores(P＜0.05).Multiple linear regression results showed that the type of hospital,the gender,whether or not they were both hospi-tal functionaries and clinical operations personnel,and the person-organisation fit were the major factors influencing the career growth of hospital managers the(P＜0.05).Conclusion The career growth of hospital managers is general-ly at an intermediate level and is affected by a variety of factors.Hospitals should pay attention to the individual characteristics and job requirements of managers,and improve career growth by completing the performance evalua-tion system,creating a good and fair organisational atmosphere,and easing career promotion stress.

Objective To observe the effects of Xuanfei Tongfu formula on the prognosis of patients with severe pneumonia.Methods Sixty patients with severe pneumonia admitted to the First People's Hospital of Fuyang District,Hangzhou City from June 1,2022 to April 1,2024 were selected as the research subjects.Patients were divided into control group(31 cases)and observation group(29 cases)by randomly number table method.Upon hospital admission,the control group received conventional Western medicine treatment,while the observation group received Xuanfei Tongfu formula in addition to conventional Western medicine treatment[Rhubarb 8 g(decocted later),Aurantii Fructus Immaturus 12 g,Magnoliae Officinalis Cortex 12 g,Agastache Rugosa 10 g,Tatarian Aster Root 15 g,Natrii Sulfas Exsiccatus 10 g(dissolved in water),decocted to 150 mL each time and taken],once a day for 5 days.Observe the changes of inflammatory indicators such as serum levels of C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)in both groups before and after treatment.To evaluate the severity indicators of diseases such as acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA),as well as the clinical efficacy after treatment.Record the duration of mechanical ventilation,intensive care unit(ICU)length of stay and total hospitalization length of the two groups,calculate the oxygenation index level,and statistically analyze the 28-day survival rate.Results Compared with before treatment,the levels of inflammatory indicators CRP,PCT,and IL-6,as well as the scores of APACHEⅡand SOFA in both groups were significantly lower than those after treatment,the oxygenation index was significantly higher than that before treatment,and the changes in the observation group were more obvious than those in the control group[CRP(mg/L):28±17 vs.50±34,PCT(μg/L):2.0±1.5 vs.4.1±2.7,IL-6(ng/L):52±28 vs.97±61,APACHEⅡscore:12.8±5.1 vs.16.1±6.1,SOFA score:3.9±1.8 vs.6.2±2.7,oxygenation index(mmHg,1 mmHg≈0.133 kPa):302±57 vs.252±85,all P<0.05].Compared with the control group,the observation group exhibited a markedly reduced duration of mechanical ventilation(days:8.3±3.8 vs.11.4±6.4,P<0.05),and a significantly higher total effective rate of clinical efficacy[82.76%(24/29)vs.54.84%(17/31),P<0.05].Conclusion The application of Xuanfei Tongfu formula can effectively enhance the clinical treatment outcomes for severe pneumonia,reduce systemic inflammatory responses,promote organ function recovery,and improve the prognosis of patients.

To explore the clinical efficacy of the modified segmented peroral endoscopic myotomy (POEM) for the treatment of achalasia (AC), AC patients admitted to the Jianhu People's Hospital from December 2019 to December 2021 were included in a retrospective cohort study. Patients received segmented POEM were included in the segmented POEM group, while patients treated with progressive POEM were included in the progressive POEM group. Perioperative indicators (including Eckardt scores preoperatively and at 6 months postoperatively), clinical efficacy, and complications were compared between the two groups. A total of 65 AC patients were included, among them, 28 patients were in the segmented POEM group, and 37 patients in the progressive POEM group. There were no significant differences in the general information of the two groups, including gender, age, lesion type, or Eckardt scores before the operation ( P>0.05). There were significant differences in the incidence of postoperative complications, including subcutaneous emphysema [3.6% (1/28) VS 24.3% (9/37), P=0.035] and small pleural effusion [7.1% (2/28) VS 27.0% (10/37), χ2=4.186, P=0.041] between the two groups. Postoperative chest pain duration (36.5±10.5 hours VS 44.3±11.8 hours, t=2.765, P=0.008), severity (4.1±2.1 VS 6.2±2.3, t=3.783, P<0.001), and fever days (2.1±1.3 days VS 3.1±1.5 days, t=2.816, P=0.007) also showed statistical difference. However, there was no significant difference in the incidence of postoperative pneumothorax between the two groups [0.0% (0/28) VS 2.7% (1/37), P=1.000]. At the 6-month follow-up, the segmented POEM group had a lower incidence of retrosternal pain and gastroesophageal reflux compared to the progressive POEM group ( P<0.05), and the Eckardt score was significantly improved (2.2±1.1 VS 2.9±1.3, t=2.294, P=0.025). Both segmented and progressive POEM are effective treatments for AC, but segmented POEM has higher safety, lower incidence of postoperative chest pain and gastroesophageal reflux complications, and better clinical efficacy.

Objective To evaluate the efficacy of combining surgical treatment with biological agents for perianal fistulizing Crohn's disease(pfCD).Methods Sixty patients with perianal fistulizing Crohn's disease(pfCD)admitted to our hospital from May 2021 to December 2023 were randomly allocated into two groups:Treatment Group A(n=30)and Treatment Group B(n=30).Treatment Group A received pfCD surgery combined with inflix-imab(IFX)and azathioprine(AZA),while Treatment Group B underwent pfCD surgery along with ustekinumab(UST)and AZA.The CDAI score,PDAI score,and Assche score were monitored for both groups,and postoperative MRI examinations were conducted to evaluate the healing of pfCD.Results There were statistically significant differences in CDAI,PDAI,and Assche scores between pre-treatment and post-treatment comparisons within treat-ment groups A and B(P<0.05),as well as in the magnitude of change at each time point.Comparisons of CDAI,PDAI,and Assche scores at 8,16,24,and 32 weeks,and PDAI scores at 40 weeks between groups A and B using independent samples t-tests did not yield statistically significant results(P>0.05).However,significant differences were observed for CDAI and Assche scores at 40 weeks(P<0.05).Significant changes in CDAI,PDAI,and Assche scores were noted at 8,16,24,32,and 40 weeks post-treatment within both groups A and B(P<0.05).Multiple comparisons using the LSD method revealed that the changes in these scores at each time point were statistically significant(P<0.05).The data indicate a temporal trend in the changes of CDAI,PDAI,and Assche scores,with group B showing a more rapid decline compared to group A.In terms of fistula response rates,both groups A and B achieved 100%(30/30).However,the clinical healing rate of fistulas was higher in group B at 86.7%(26/30)compared to 76.7%(23/30)in group A.Conclusion The combination of surgical treatment with IFX/UST plus AZA is safe and effective for treating pfCD.However,the long-term efficacy of combining surgical treatment with UST appears to be superior.