AIM: To investigate variation patterns of corneal biomechanical parameters and binocular symmetry among children of different genders aged 8-16 years.METHODS:A retrospective study was conducted, and children who underwent optometric examinations at the ophthalmology department of our hospital were enrolled between January 2022 and December 2024. Measurements included the flat keratometry(K1), steep keratometry(K2), and mean curvature(Km)of the anterior corneal surface, horizontal visible iris diameter(HVID), central corneal thickness(CCT), corneal endothelial cell density(CECD), average cell size(ACS), coefficient of variation(CV), and hexagonality(HEX). Corneal parameters and binocular differences were compared between genders and across age groups.RESULTS:A total of 621 children(1 242 eyes)were enrolled in this study, including 284 males(568 eyes), 337 females(674 eyes), 528 children aged 8-12 years(1 056 eyes), and 93 children aged 13-16 years(186 eyes). In children aged 8-16 years, the K1, K2, Km and CV of both eyes, as well as the interocular CCT differences in boys were significantly lower than those in girls(all P<0.05), while the HVID and HEX of both eyes, as well as the CCT of the left eye in boys were significantly higher than those in girls(all P<0.05). Children aged 8-12 years had significantly higher K1, Km, CECD and HEX in both eyes, and significantly lower ACS in both eyes than those aged 13-16 years(all P<0.05). K1, K2, Km, CECD and HEX in both eyes were negatively correlated with age(P<0.05); ACS in both eyes was positively correlated with age(P<0.001); K1 and Km of the right eye were positively correlated with the CECD of the right eye(P<0.05), and K1 and CCT of the left eye were positively correlated with the CECD of the left eye(P<0.05).CONCLUSION:Significant gender differences exist in corneal parameters among children aged 8 to 16 years, while binocular symmetry remained stable.

OBJECTIVE To investigate the prevalence and influencing factors of potentially inappropriate medication （PIM） among the elderly in nursing homes in Urumqi based on three PIM screening tools， and to compare the applicability of different tools. METHODS A cross-sectional study design was adopted. Elderly individuals from six nursing homes in Urumqi were selected as the research subjects from May 2021 to September 2023. Demographic characteristics， disease burden and medication records of the elderly were collected. PIM screening was performed using the Chinese PIM criteria （2024 edition）， the American Geriatrics Society （AGS） Beers criteria （2023 edition）， and the Screening Tool of Older Person’S Prescriptions（STOPP）/Screening Tool to Alert to Right Treatment（START） （2023 edition）. Fleiss’s Kappa test was used to assess the consistency among the three screening tools， and multivariate Logistic regression was used to analyze the influencing factors of PIM. RESULTS The prevalence of PIM screened by the Chinese PIM criteria was 47.4% （323/682）， by the AGS Beers criteria was 43.4% （296/682）， and by the STOPP criteria was 50.9% （347/682）. The consistency among the three screening tools was low （Fleiss’s Kappa＝0.12， P ＜0.001）. Multivariate Logistic regression analysis showed that all three screening tools indicated that polypharmacy， aspirin use and psychotropic drug use were independent risk factors for PIM among elderly in nursing houses （all OR＞1， P ＜0.05）. CONCLUSIONS The prevalence of PIM among the elderly in nursing homes in Urumqi is relatively high. Polypharmacy， aspirin use and psychotropic drug use are common independent risk factors for PIM. There are differences in screening results among the three tools with low consistency. The Chinese PIM criteria can serve as a first-line tool for PIM screening in nursing homes.

Background Long-term exposure to ambient fine particulate matter (PM_2.5) is a significant risk factor for cardiometabolic disorders. However, the mechanisms of its interaction with the endogenous circadian system remain incompletely understood. Objective To investigate whether chronic PM_2.5 exposure interferes with the rhythmic expression of the cardiac circadian clock, thereby disrupting downstream antioxidant defenses and metabolic homeostasis, and ultimately driving cardiometabolic dysfunction. Methods Seventy-two male C57BL/6 mice were randomly divided into a PM_2.5 exposure group (PM group) and a filtered air control group (FA group). Whole-body exposure was conducted for 8 weeks in a meteorological environmental animal exposure system. Samples were collected at six distinct zeitgeber time (ZT) points post-exposure. The 24 h ambulatory blood pressure and serum lipid profiles were monitored. Rhythm parameters were derived via cosinor analysis to compare differences in Midline statistic of rhythm (Mesor), amplitude, and phase between the two groups. The rhythmic expression of core circadian clock genes and antioxidant genes in the myocardium was detected by quantitative polymerase chain reaction (qPCR). Myocardial reactive oxygen species (ROS) levels and downstream pathway protein expression were analyzed by immunofluorescence and Western blot (WB), respectively. The expression changes of the clock gene retinoic acid receptor-related orphan receptor α (RORα) were assessed at both the mRNA and protein levels. Finally, Spearman correlation analysis was used to explore the relationships among myocardial RORα expression, lipid profiles, and oxidative stress indicators. Results Compared to the FA group, mice in the PM group exhibited a blunted circadian rhythm in blood pressure, characterized by sustained elevation throughout the day. Chronic PM_2.5 exposure showed a significant interaction with ZT on systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) (F-interaction=9.11, 5.70, and 6.02, respectively; P<0.05), as well as on serum triglycerides (TG), total cholesterol (T-CHO), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) (F-interaction=16.32, 11.12, 15.39, and 28.09, respectively; P<0.05). Cosinor analysis further revealed that the Mesor values of T-CHO, TG, and LDL-C were significantly increased (P<0.05), while that of HDL-C was significantly decreased in the PM group (P<0.05). The oscillation amplitudes of SBP, DBP, and MAP showed a decreasing trend, whereas those of TG and LDL-C were significantly increased (P<0.05). Furthermore, SBP, T-CHO, and HDL-C all exhibited a significant phase delay (P<0.05). Mechanistically, PM_2.5 exposure significantly suppressed the expression of the positive circadian regulator RORα in the myocardium, leading to disordered rhythmic expression of core clock genes (Bmal1, Clock, Per1/2, and Cry1/2). This exposure also inhibited the rhythmic expression of antioxidant genes (GPX1, SOD2, and CAT), resulting in increased ROS generation and elevated expression of calcium/calmodulin-dependent protein kinase II (CaMKII) and reduced nicotinamide adenine dinucleotide phosphate (NADPH) proteins. Correlation analysis further revealed that myocardial RORα expression level was negatively correlated with T-CHO, TG, and LDL-C (r=−0.55, −0.63, and −0.51, respectively; P<0.001), and positively correlated with HDL-C (r=0.37, P=0.010), and antioxidant genes GPX1, SOD2, and CAT expression (r=0.34, 0.35, and 0.56, respectively; P < 0.001). Conclusion Chronic PM_2.5 exposure induces cardiometabolic dysfunction by suppressing myocardial RORα expression. This suppression disrupts the cardiac circadian clock and the diurnal balance of oxidative stress, triggering oxidative damage and elevating expression of CaMKII/NADPH pathway proteins. Collectively, these alterations precipitate the loss of cardiac metabolic rhythms and subsequent functional impairment.

OBJECTIVE To provide evidence for further improving the rules governing the renewal round of national centralized drug procurement with volume-based purchasing （VBP） program for insulin.METHODS Based on publicly available policy documents， selection outcomes， and interview data， policy text analysis， descriptive statistical analysis， the Wilcoxon signed-rank test， and thematic analysis were used to compare the procurement rules and selection outcomes between the initial and renewal rounds of the national VBP programs for insulin， and to examine the mechanisms linking rule adjustments to changes in selection outcomes.RESULTS Compared with the initial round， the renewal round retained the six procurement groups and 11 bidding units， reduced the maximum valid bid price by 40%， and introduced competitive bidding selection， revival selection， and a price line for Category A products. A total of 42 products were selected in the initial round and 49 in the renewal round， including 37 that remained selected， 5 that exited， and 12 that were newly selected in the renewal round. Within the same procurement groups， the price range decreased significantly in the renewal round compared with the initial round （ P ＝0.031）， whereas the difference in average price between the two was not statistically significant （ P ＝0.063）. Domestic manufacturers were more likely to enter the A1 category， whereas multinational manufacturers were more likely to remain in categories B/C. Mechanism analysis suggested that the price line shaped the boundary of selected prices， while the classification and volume-allocation rules linked manufacturers’ bidding decisions to expected procurement volumes， potentially altering bidding incentives and corresponding to changes in the distribution of selection outcomes.CONCLUSIONS The renewal round of the insulin VBP program established an interrelated mechanism involving price boundaries， volume-based incentives， and supply constraints through the use of price lines， product classification， and contracted volume allocation. These rule adjustments corresponded to changes in the structure of selected products， price distributions， and manufacturer classifications. Future policy refinement should strengthen the coordination among reasonable price ranges， volume-based incentives， and supply performance.

Omental torsion represents a rare cause of acute abdomen，current literatures predominantly limited to case reports focusing on greater omentum torsion，by contrast，lesser omentum torsion is exceedingly uncommon. One case of male patient aged 8 years and 7 months with epigastric pain was admitted to the Children's Hospital of Zhejiang University School of Medicine. Initial abdominal ultrasound suggested omental pathology. To confirm the diagnosis，repeat ultrasonography and contrast-enhanced CT were performed，leading to a preliminary suspicion of greater omentum torsion. Following multidisciplinary collaborative consultation，surgical intervention was recommended. The patient underwent laparoscopic omentectomy with adhesiolysis，which intraoperatively confirmed lesser omentum torsion. Histopathological examination provided definitive diagnostic confirmation.Postoperative abdominal ultrasound revealed no significant abnormalities. This case underscored the critical value of dynamic multimodal imaging evaluation and multidisciplinary decision-making in the preoperative diagnosis and therapeutic management of lesser omentum torsion，aiming to establish ultrasonographic diagnostic references for lesser omentum torsion while simultaneously heightening clinical vigilance toward rare diseases.

[Objective]To construct a prediction model for brucellosis by using a deep neural network algorithm to improve the early detection.[Methods]We collected the clinical data of 202 brucellosis patients and 319 non-brucellosis patients admitted to Hohhot Occupational Disease Prevention and Treatment Hospital in 2023,and analyzed data such as gender,age,blood routine indices and clinical diagnosis.A prediction model for brucellosis was constructed by using a deep neural network algorithm and optimized through 10-fold cross-validation.Performance metrics included sensitivity,false negative rate,specificity,false positive rate,accuracy,positive predictive value,negative predictive value,F1 score,and area under the receiver operating characteristic curve(AUC).The optimal model was interpreted by using SHapley Additive exPlanations(SHAP)to clarify decision-making logic and feature influencing mechanisms.[Results]Data visualization analysis revealed no significant difference between brucellosis and non-brucellosis groups.The optimal model demonstrated good performance:sensitivity(85.3%),specificity(92.1%),accuracy(89.5%),AUC(96.6%),95%CI(0.937,0.977).SHAP analysis identified age,platelet count,mean platelet volume,basophil ratio,red blood cell distribution width,and absolute basophil count as significant predictors of brucellosis.[Conclusions]The deep neural network prediction model constructed in this study has good performance and can provide reliable support for the early diagnosis,prevention and control of brucellosis.Identification of key brucellosis-related influencing features will help further understand the pathogenesis of the disease,and this model holds promise for broad clinical application in the future.

Objective To investigate the clinical effect of simultaneous use of three endoscopes(laparoscope,choledochoscope,and duodenoscope)combined with holmium laser in the treatment of gallstones complicated with common bile duct stones.Methods A prospective randomized controlled study was carried out.A total of 80 patients with cholecystolithiasis combined with choledocholithiasis in our hospital from August 2022 to January 2024 were selected and divided into three-endoscope group(n=40)and two-endoscope group(n=40)according to random number table method.Patients in the three-endoscope group underwent laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)combined with holmium laser lithotripsy,primary closure of the common bile duct,endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic nasobiliary drainage(ENBD),while the two-endoscope group underwent LC+LCBDE+T-tube drainage.The intraoperative bleeding volume,operation time,hospitalization time,hospitalization costs,and postoperative complications between the two groups were observed and analyzed.Results There was no significant difference in intraoperative bleeding volume between the two groups[(55.6±14.3)ml vs.(53.2±16.3)ml,t=0.703,P=0.484].The operation time of the three-endoscope group was significantly longer than that in the two-endoscope group[214.5(171.5,246.8)min vs.178.0(151.0,227.8)min,Z=-2.069,P=0.039].The length of hospital stay in the three-endoscope group was significantly shorter than that in the two-endoscope group[(13.2±3.3)d vs.(16.2±3.7)d,t=3.864,P=0.001].The hospitalization costs were significantly higher in the three-endoscope group than those in the two-endoscope group[39 316.0(32 338.5,43 421.0)yuan vs.33 717.0(30 873.3,37 813.3)yuan,Z=-3.272,P=0.001].There were no significant differences in the incidence of postoperative pancreatitis[2.5%(1/40)vs.2.5%(1/40),χ2=0.000,P=1.000],the incidence of bile leakage[7.5%(3/40)vs.2.5%(1/40),χ2=0.263,P=0.615],and residual stone rate[7.5%(3/40)vs.0.0%(0/40),P=0.241]between the two groups.Forty cases in the three-endoscope group were followed up for 2-20 months,with a median of 13 months.One case of stone recurrence occurred at 8 months after surgery.Forty patients in the two-endoscope group were followed up for 1-21 months,with a median of 15 months.There was 1 case of stone recurrence at 6 and 10 months postoperatively,respectively.There was no statistically significant difference in stone recurrence rate between the two groups[2.5%(1/40)vs.5.0%(2/40),χ2=0.000,P=1.000].Conclusions LC+LCBDE combined with holmium laser lithotripsy,primary closure of the common bile duct,ERCP,and ENBD in the treatment of cholecystolithiasis and choledocholithiasis can shorten the hospitalization time.The replacement of T-tube with nasobiliary duct protects the function of the Oddi sphincter,which is more in line with the concept of minimally invasive surgery and worthy of clinical application.

Objective To explore the efficacy of precise surface positioning method in percutaneous screw fixation for Jones fracture.Methods Data of 46 patients with Jones fractures admitted to our hospital from September 2021 to December 2023 were retrospectively analyzed.According to the different treatment methods,the patients were divided into screw groups(24 patients fixed by percutaneous screws)and tension band groups(22 patients fixed by incision and reset tension band).The general conditions,follow-up time,surgical time,hospitalization time,fracture reduction quality,postoperative complete weight-bearing time,fracture healing time,and complications in the two groups were recorded and compared.The American Association of Foot and Ankle Surgery(AOFAS)system was used to assess the recovery of foot function.Results There was no statistically significant difference in the general data before the operation between the two groups of patients(P＞0.05).The follow-up time of the two groups was 6 to 24 months.Compared with the tension band group,the screw group had shorter operation time[(32.96±5.35)min vs.(47.27±9.42)min],shorter hospitalization time[(5.75±1.18)d vs.(7.68±2.05)d],earlier postoperative complete weight-bearing time[(6.47±0.73)w vs.(7.29±1.66)w],faster fracture healing time[(3.31±0.68)months vs.(4.29±1.29)months],higher AOFAS score[(89.13±2.62)vs.(79.59±4.49)](all P＜0.05).The tension band group of fracture reduction quality was better than the screw group(P＜0.05).The quality of fracture reduction during the operation in the tension band group was better than that in the screw group(P＜0.05).In terms of complications:no complications occurred in the screw group,one patient in the tension band group developed infection,and one patient had a loose Kirchner needle.Conclusion Precise surface positioning method in percutaneous screw fixation for Jones fracture is a safe and effective method with precise positioning,simple operation,small trauma,and rapid rehabilitation,which is worthy of clinical promotion,but the indications need to be strictly controlled according to the type of fracture.

Integrated medical curriculum is an important direction for the development of medical education. While integrated theoretical courses have been practiced for many years, integrated experiments are still in the exploratory stage. Taking the integrated experiments of medical microbiology and immunology in Xi'an Jiaotong University as an example, this article introduces the design concept, implementation details, effectiveness evaluation, improvements, and prospects of integrated experiments established based on clinical practice principles, so as to provide a reference for further optimization of integrated experiments in the future.

Objective:To investigate the clinical application effect and preliminary experience of ureteroscopy-assisted flexible ureteroscopic lithotripsy in the treatment of transplanted kidney stones.Method:A retrospective analysis was conducted on the clinical data of 9 kidney transplant recipients with graft stones who underwent ureteroscopy-assisted flexible ureteroscopic lithotripsy at the First Affiliated Hospital of Zhengzhou University between January 2020 and January 2023. The recipients' general information, surgical procedures, and postoperative outcomes were reviewed and summarized. Additionally, a comprehensive literature search was performed in both Chinese and international databases, including CNKI, Wanfang, and the China Academic Journals Full-text Database, as well as PubMed and Web of Science. The search terms included " kidney transplant" "flexible ureteroscope" "ureteroscope" and " urinary tract stones" . The search covered all publications available up to December 2023.Result:The 9 recipients had a mean age of 37. 56 years (range: 27–54 years) . The onset time of the kidney stones ranged from 1 to 13 months after kidney transplantation. All recipients were diagnosed with transplanted kidney stones by CT and showed no symptoms of kidney colic at the time of onset. All transplanted kidneys were located in the right iliac fossa, with varying degrees of hydronephrosis. The smallest stone diameter was 0. 5 cm, and the largest was 1. 3 cm. The number of stones ranged from 1 to 3 per recipient; 6 cases had solitary stones, and 3 had multiple stones in the renal pelvis and calyces. In all 9 surgeries, the ureteral orifice of the transplanted kidney was located at the apex of the bladder using ureteroscopy, and a hydrophilic guidewire was inserted into the renal pelvis. A second ureteroscopy was then performed, guiding the ureteroscope tip into the transplanted ureteral orifice in coaxial alignment with the guidewire. A flexible ureteroscope sheath was advanced along the guidewire, followed by the insertion of a digital flexible ureteroscope to perform holmium laser dusting lithotripsy. Stone composition analysis revealed mixed calcium oxalate monohydrate and calcium oxalate dihydrate. The surgical duration ranged from 30 to 75 minutes. No complications such as massive bleeding, septic shock, or rejection occurred. Postoperative review at 1 month, after ureteral stent removal, showed no residual stones in any patient. During 6 months of follow-up, no recurrence of stones was observed, and the renal function of the transplanted kidneys remained stable compared to preoperative levels. A total of 19 related articles were identified through literature review, including 11 in English and 8 in Chinese. Chinese reports on transplanted kidney stones were all from single-center studies with small case numbers. In contrast, foreign meta-analyses and multicenter studies showed that treatments for transplanted kidney stones abroad mainly included antegrade/retrograde ureteroscopy and percutaneous nephroscopy.Conclusion:Ureteroscopy-assisted flexible ureteroscopic lithotripsy is a feasible treatment for transplanted kidney stones. It can effectively protect graft kidney function and has promising clinical application prospects.