AIM: To investigate the differences in morphological structure and retinal blood perfusion between the affected eye and the contralateral healthy eye using optical coherence tomography angiography(OCTA)in patients with idiopathic macular epiretinal membrane(IMEM)before and after surgery, and to evaluate the association of these parameters with functional and anatomical outcomes to inform prognostic assessment. METHODS:A prospective study was conducted at Zhejiang Provincial People's Hospital between January 2023 and December 2024. Consecutive patients diagnosed with unilateral IMEM were enrolled; the fellow eye served as an internal control. All participants underwent standardized ophthalmic evaluations, including optical coherence tomography(OCT), OCTA, and color fundus photography. Key quantitative parameters assessed included best-corrected visual acuity(BCVA), central macular thickness(CMT), foveal avascular zone(FAZ)area, vessel density in the inner capillary plexus(ICP), superficial capillary plexus(SCP), deep capillary plexus(DCP), and choroidal capillary perfusion area(CCPA). Measurements were obtained preoperatively and at 1 and 3 mo postoperatively. Correlation analyses were performed between the above parameters and postoperative BCVA and CMT.RESULTS: This study enrolled 30 patients(60 eyes)diagnosed with IMEM, comprising 14 males and 16 females, with a mean age of 65.4±10.8 y.At baseline, IMEM-affected eyes demonstrated significantly reduced BCVA, DCP density, and FAZ area, alongside significantly increased CMT and CCPA, compared with contralateral controls. Following vitrectomy with membrane peeling, CMT decreased significantly at both 1 and 3 mo(both P<0.05)postoperatively; DCP density and BCVA showed significant improvement(both P<0.05). No significant change in FAZ area was observed postoperatively(P>0.05). At 3 mo postoperatively, BCVA of the affected eye was negatively correlated with CMT(r=-0.549, P=0.022). At 1 mo postoperatively, CMT was negatively correlated with preoperative DCP and FAZ, positively correlated with preoperative CMT, and positively correlated with ICP and SCP at 1 mo postoperatively, and negatively correlated with FAZ at 1 mo postoperatively(all P<0.05). Furthermore, CMT at 3 mo postoperatively was negatively correlated with preoperative DCP(r=-0.498,P=0.042).CONCLUSION:In patients with IMEM, the affected eyes exhibit significantly reduced DCP density and FAZ area, alongside increased CMT and CCPA. Following vitrectomy with membrane peeling, CMT decreased progressively, DCP density demonstrated partial restoration, and vision improved gradually. Preoperatively, smaller CMT larger DCP, and FAZ were associated with more favorable surgical outcomes; postoperatively, smaller ICP and SCP densities—combined with a larger FAZ—also correlated with better functional recovery.

Cannabidiol(CBD),a natural,non-toxic,non-psy-choactive cannabinoid extracted from Cannabis sativa L,has a wide range of pharmacological activities,including anti-inflam-matory,antioxidant,immunomodulatory,analgesic,anti-tumor,anti-convulsant,anxiolytic effects.Recent studies have indica-ted that CBD may have potential neuroprotective effects in vari-ous models of central nervous system diseases.This paper re-views the experimental research progress of CBD in central nerv-ous system diseases and its possible neuroprotective mecha-nisms,aiming to provide references for its clinical application and new drug development.

Objective:To investigate the relationship between different types of tea intake and COVID-19 infection.Methods:Data were retrieved from a genome-wide association study(GWAS),involving 447 485,and 64 949 people for single nucleotide polymorphisms(SNPs).Two-sample Mendelian randomization(MR)analysis was used to investigate the relationship of different types of tea intake with four subgroups of COVID-19 infected population,including COVID-19 infected population versus general population,COVID-19 hospitalized population versus general population,COVID-19 hospitalized population versus non-hospitalized population,and very severe respiratory confirmed population versus general population.Inverse-variance weighted(IVW)method was used as the main method of causal analysis.MR Egger intercept was used for pleiotropy test,and Cochran's Q-statistic was used for heterogeneity test.Results:Compared to the general population,tea intake decreased the incidence of COVID-19 in the infection population(IVW method,OR=0.806,95%CI:0.651-0.999),and the hospitalized population(IVW method,OR=0.533,95%CI:0.369-0.770).Additionally,the underlying pleiotropy was not found following the MR-Egger regression intercept(MR intercept=-0.002,P=0.667),and the Cochran's Q-statistic showed no heterogeneity(Q-statistic=52.712,P=0.057).Compared to the general population,the underlying pleiotropy in the hospitalized patients was not found by MR-Egger regression intercept(MR intercept=-0.001,P=0.909),and the Cochran's Q-statistic showed no heterogeneity(Q-statistic=25.214,P=0.945).However,green tea and herbal tea had no effect on COVID-19 infection.Conclusions:Overall tea intake reduces the risk of COVID-19 infection in the general population compared to COVID-19 infected and hospitalized populations,while green tea and herbal tea have no protective effect against COVID-19 infection.

Objective To examine the effect and electrophysiological mechanism of repetitive transcranial magnetic stimulation(rT-MS)augmentated to group cognitive training(GCT)on children with high-functioning autism spectrum disorder(ASD)comorbided with attention-deficit/hyperactivity disorder(ADHD).Methods From March to December,2023,70 children diagnosed with ASD+ADHD were recruited from the Affiliated Xuzhou Children's Hospital of Xuzhou Medical University and partnering special education centers.They were randomly divided into control group(n=35)and experimental group(n=35).Both groups received standard-ized GCT,twice a week,for ten weeks.During the same period,the control group received sham stimulation,while the experimental group additionally received 1 Hz rTMS over the right temporoparietal junction at 80%of resting motor threshold,five times a week,for ten weeks.Core symptoms were assessed before and after treat-ment with the Social Responsiveness Scale-2(SRS-2),Repetitive Behavior Scale-Revised(RBS-R)and Conners Parent Rating Scale-3(CPRS-3)attention-deficit and hyperactivity/impulsivity subscales.Resting-state EEG was simultaneously recorded to obtain θ and β power spectral density(PSD)and the θ/β ratio at Fz,Cz and Pz.Results Two cases in the control group and one in the experimental group dropped down.After treatment,SRS-2 scores(|Z|>4.876,P<0.001)and RBS-R scores(|Z|>4.329,P<0.001)decreased in both groups.CPRS-3 attention-deficit scores(|Z|>4.940,P<0.001)and hyperactivity/impulsivity scores(|t|>16.273,P<0.001)decreased in both groups,and they were lower in the experimental group(Z=4.732,P<0.001;t=-3.169,P<0.01).In the experimental group,Fz θ-PSD decreased significantly(Z=-4.830,P<0.001),and it was lower than that in the control group(Z=-2.609,P=0.009);and the θ/β ratio likewise fell(t=4.754,P<0.001),and it was lower than that in the control group(t=-2.256,P=0.027).Conclusion Adding rTMS to GCT can further alleviate attention deficits and hyperactive-impulsive symptoms in chil-dren with ASD comorbided with ADHD,which may associate with the inhibit of power of θ wave in profrontal contex.

Objective:To observe the efficacy of probiotics in the adjuvant treatment of bronchial asthma and to explore the relationship between their action and intestinal flora.Methods:A total of 76 newly diagnosed patients with mild-to-moderate bronchial asthma treated at Baotou Central Hospital between November 2023 and January 2025 were randomly divided into two groups:the conventional treatment group(n=38)and the combined probiotic treatment group(n=38).Post-treatment comparisons were made between the two groups regarding symptom resolution time,Asthma Control Test(ACT)scores,lung function,fractional exhaled nitric oxide(FeNO)levels,serum inflammatory cytokines,complement levels,and other indicators.Faecal samples were collected for 16S rDNA sequencing of gut microbiota.Results:Baseline characteristics showed no significant differences between the two groups(P＞0.05).Compared to the conventional treatment group,the combined probiotic group exhibited significantly shorter resolution times for asthma symptoms and lung rales(P＜0.001),significantly higher ACT scores,FEV1,and PEF(P＜0.001),and significantly lower FeNO levels(P＜0.001).Additionally,serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and complement C3 levels were significantly reduced(P＜0.001),while serum interleukin-6(IL-10)levels were significantly increased(P＜0.001).16S rDNA sequencing revealed no significant changes in gut microbiota richness or diversity in the conventional treatment group before and after treatment(P＞0.05),whereas intestinal flora richness and diversity were significantly increased in the combined probiotic treatment group compared to the pre-treatment group(P＜0.05).Correlation analysis between gut microbiota and inflammatory markers demonstrated that Faecalibacterium and Bifidobacterium abundance were negatively correlated with TNF-α levels(P＜0.05),while Escherichia-Shigella,and Streptococcus abundance were positively correlated with TNF-α levels(P＜0.05).Streptococcus and Klebsiella abundance were positively correlated with IL-6 levels(P＜0.05).Escherichia-Shigella and Streptococcus abundance were negatively correlated with IL-10 levels and positively correlated with complement C3 levels(P＜0.05).Conclusion:Probiotics may assist in improving bronchial asthma symptoms by influencing the gut flora to reduce the inflammatory response.

Objective:To investigate effect of comprehensive management intervention based on WeChat multimedia classroom on cardiac function and prognosis in elderly patients with acute myocardial infarction(AMI).Methods:Clinical data of 118 elderly patients diagnosed with AMI in the Second Affiliated Hospital of Chinese PLA Air Force Military Medical University between August 2021 and December 2022 were retrospectively collected.According to nursing way after operation,they were divided into control group(n=60,comprehensive management interven-tion)and intervention group(n=58,comprehensive management intervention based on WeChat multimedia class-room),both groups were intervened for 5 months.Cardiac function,exercise tolerance,compliance to rehabilita-tion management,self-efficacy and healthy behavior were compared between two groups.Kaplan-Meier survival curve was employed to compare incidence of adverse cardiovascular events during follow-up between two groups.Results:After 5-month intervention,compared with patients in control group,those in intervention group had sig-nificant higher left ventricular ejection fraction(LVEF)[(58.14±1.88)％vs.(54.48±1.34)％],6min walking distance(6MWD)[(490.41±59.59)m vs.(394.97±28.20)m],scores of compliance to rehabilitation manage-ment[(6.97±2.03)points vs.(5.03±1.40)points],General Self-Efficacy Scale(GSES)[(30.34±4.67)points vs.(23.55±4.86)points]and Health Promoting Lifestyle Profile-Ⅱ[(137.62±30.17)points vs.(115.95±22.66)points],and significant lower left ventricular end-diastolic volume(LVEDV)[(117.90±4.22)ml vs.(131.28±3.61)ml],left ventriadar end-systolic volume(LVESV)[(54.46±2.10)ml vs.(63.15±2.06)ml],serum brain natriuretic peptide(BNP)[(362.32±25.36)pg/ml vs.(567.58±21.90)pg/ml]and incidence of ad-verse cardiovascular events(6.90％vs.21.67％)(P＜0.05 or＜0.01).Conclusion:Comprehensive management intervention based on the WeChat multimedia classroom could significantly improve cardiac function,exercise toler-ance,compliance to rehabilitation,self-efficacy and healthy behavior,and reduce incidence of adverse cardiovas-cular events after operation in elderly AMI patients.

Objective:To observe the efficacy and safety of adrenocorticotropic hormone (ACTH) therapy in children with steroid dependent nephrotic syndrome (SDNS)/frequently relapsed nephrotic syndrome (FRNS).Methods:The clinical data of children with SDNS/FRNS who received treatment with prednisone acetate tablets were retrospectively collected from June 2019 to June 2023 in the Nephrology Department of Xi′an Children′s Hospital. The children were divided into glucocorticoid+ACTH group and glucocorticoid group, according to whether ACTH was used or not. The differences in cortisol, total cholesterol and 24 hour urinary protein quantity between 2 groups of children at baseline and follow-up endpoints were compared, and the effectiveness (the proportion of no recurrence and discontinuation of glucocorticoid) and occurrence of adverse reactions were evaluated.Results:A total of 39 patients with SDNS/FRNS were included in this study, with 21 cases in the glucocorticoid+ACTH group and 18 cases in the glucocorticoid group. Among the 39 children, there were 33 cases of SDNS and 6 cases of FRNS, respectively. The proportion of baseline low cortisol levels was 76.9% (30/39). The proportion of cortisol levels returning to normal after ACTH treatment in the glucocorticoid+ACTH group was 76.2% (16/21). The baseline and follow-up endpoint for cortisol levels in the glucocorticoid+ACTH group were 28.0(19.8, 51.5) μg/L and 79.9(58.9, 113.0) μg/L, respectively. The baseline and follow-up endpoint for cortisol levels in the glucocorticoid group were 21.0(15.8, 37.4) μg/L and 25.3(18.2, 51.4) μg/L, respectively. In the 2 groups of cortisol levels, there was statistically significant difference in the interaction effect between time and group ( Wald χ2=11.595, P=0.001), there was a statistically significant difference at the follow-up endpoint between the 2 groups ( Wald χ2=19.462, P<0.001), and the difference was statistically significant in the time effect of the glucocorticoid+ACTH group ( Wald χ2=21.100, P<0.001). The baseline and follow-up endpoint for total cholesterol in the glucocorticoid+ACTH group were 4.95(4.23, 5.26) mmol/L and 4.38(4.04, 5.24) mmol/L, respectively. The baseline and follow-up endpoint for total cholesterol in the glucocorticoid group were 4.80 (4.17, 5.28) mmol/L and 5.74 (5.04, 6.88) mmol/L, respectively. In the 2 groups of total cholesterol, there was statistically significant difference in the interaction effect between time and group ( Wald χ 2=9.842, P=0.002), there was statistically significant difference at the follow-up endpoint between the 2 groups ( Wald χ 2=12.187, P<0.001), the difference was statistically significant between the 2 groups in the time effect at baseline and the follow-up endpoint (glucocorticoid+ACTH group: Wald χ 2=6.488, glucocorticoid group: Wald χ2=7.112; all P<0.05). The baseline and follow-up endpoint for 24 hour urinary protein quantity in the glucocorticoid+ACTH group were 115 (105, 128) mg/d and 121 (113, 128) mg/d, respectively. The baseline and follow-up endpoint for 24 hour urinary protein quantity in the glucocorticoid group were 118 (113, 125) mg/d and 138 (119, 2 100) mg/d, respectively. In the 2 groups of 24 hour urinary protein quantity, there was statistically significant difference in the interaction effect between time and group ( Wald χ2=7.743, P=0.005), there was statistically significant difference at the follow-up endpoint between the 2 groups ( Wald χ2=7.779, P=0.005), and the difference was statistically significant in the time effect of the glucocorticoid group ( Wald χ2=13.331, P<0.001). The proportion of no recurrence (17/21) and discontinuation of oral glucocorticoid (16/21) in the glucocorticoid+ACTH group were higher than those in the glucocorticoid group (the proportion were both 6/18), and the differences between the 2 groups were statistically significant (the chi square values were 9.084 and 7.240, respectively; all P<0.01). No adverse reactions occurred in the glucocorticoid group. The incidence of adverse reactions in the glucocorticoid+ACTH group was 14.3% (3/21), of which 2 cases developed generalized urticaria and 1 case developed hypertension. Conclusions:ACTH has a good efficacy and safety in children with SDNS/FRNS. The results of this study need to be further validated by increasing the sample size and conducting multicenter studies.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective To examine the effect and electrophysiological mechanism of repetitive transcranial magnetic stimulation(rT-MS)augmentated to group cognitive training(GCT)on children with high-functioning autism spectrum disorder(ASD)comorbided with attention-deficit/hyperactivity disorder(ADHD).Methods From March to December,2023,70 children diagnosed with ASD+ADHD were recruited from the Affiliated Xuzhou Children's Hospital of Xuzhou Medical University and partnering special education centers.They were randomly divided into control group(n=35)and experimental group(n=35).Both groups received standard-ized GCT,twice a week,for ten weeks.During the same period,the control group received sham stimulation,while the experimental group additionally received 1 Hz rTMS over the right temporoparietal junction at 80%of resting motor threshold,five times a week,for ten weeks.Core symptoms were assessed before and after treat-ment with the Social Responsiveness Scale-2(SRS-2),Repetitive Behavior Scale-Revised(RBS-R)and Conners Parent Rating Scale-3(CPRS-3)attention-deficit and hyperactivity/impulsivity subscales.Resting-state EEG was simultaneously recorded to obtain θ and β power spectral density(PSD)and the θ/β ratio at Fz,Cz and Pz.Results Two cases in the control group and one in the experimental group dropped down.After treatment,SRS-2 scores(|Z|>4.876,P<0.001)and RBS-R scores(|Z|>4.329,P<0.001)decreased in both groups.CPRS-3 attention-deficit scores(|Z|>4.940,P<0.001)and hyperactivity/impulsivity scores(|t|>16.273,P<0.001)decreased in both groups,and they were lower in the experimental group(Z=4.732,P<0.001;t=-3.169,P<0.01).In the experimental group,Fz θ-PSD decreased significantly(Z=-4.830,P<0.001),and it was lower than that in the control group(Z=-2.609,P=0.009);and the θ/β ratio likewise fell(t=4.754,P<0.001),and it was lower than that in the control group(t=-2.256,P=0.027).Conclusion Adding rTMS to GCT can further alleviate attention deficits and hyperactive-impulsive symptoms in chil-dren with ASD comorbided with ADHD,which may associate with the inhibit of power of θ wave in profrontal contex.

Objective:To observe the efficacy of probiotics in the adjuvant treatment of bronchial asthma and to explore the relationship between their action and intestinal flora.Methods:A total of 76 newly diagnosed patients with mild-to-moderate bronchial asthma treated at Baotou Central Hospital between November 2023 and January 2025 were randomly divided into two groups:the conventional treatment group(n=38)and the combined probiotic treatment group(n=38).Post-treatment comparisons were made between the two groups regarding symptom resolution time,Asthma Control Test(ACT)scores,lung function,fractional exhaled nitric oxide(FeNO)levels,serum inflammatory cytokines,complement levels,and other indicators.Faecal samples were collected for 16S rDNA sequencing of gut microbiota.Results:Baseline characteristics showed no significant differences between the two groups(P＞0.05).Compared to the conventional treatment group,the combined probiotic group exhibited significantly shorter resolution times for asthma symptoms and lung rales(P＜0.001),significantly higher ACT scores,FEV1,and PEF(P＜0.001),and significantly lower FeNO levels(P＜0.001).Additionally,serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and complement C3 levels were significantly reduced(P＜0.001),while serum interleukin-6(IL-10)levels were significantly increased(P＜0.001).16S rDNA sequencing revealed no significant changes in gut microbiota richness or diversity in the conventional treatment group before and after treatment(P＞0.05),whereas intestinal flora richness and diversity were significantly increased in the combined probiotic treatment group compared to the pre-treatment group(P＜0.05).Correlation analysis between gut microbiota and inflammatory markers demonstrated that Faecalibacterium and Bifidobacterium abundance were negatively correlated with TNF-α levels(P＜0.05),while Escherichia-Shigella,and Streptococcus abundance were positively correlated with TNF-α levels(P＜0.05).Streptococcus and Klebsiella abundance were positively correlated with IL-6 levels(P＜0.05).Escherichia-Shigella and Streptococcus abundance were negatively correlated with IL-10 levels and positively correlated with complement C3 levels(P＜0.05).Conclusion:Probiotics may assist in improving bronchial asthma symptoms by influencing the gut flora to reduce the inflammatory response.