Keratoconus is an adolescent-onset blinding eye disease characterized by the protrusion and thinning of the central or paracentral cornea. The cause of keratoconus remains unclear, though its onset and progression arise from a multifactorial interplay involving a polygenic background, environmental exposures, and biomechanical decompensation. Recent studies have demonstrated significant gender differences in the pathogenesis and progression of keratoconus.At the epidemiological level, most studies suggest that the disease shows a male predominance; in terms of clinical features, male patients tend to experience an earlier onset and present with more severe clinical phenotypes, such as more serious corneal morphological deterioration; at the pathological mechanism level, sex hormone expression differences and genetic susceptibility differences play a key role in disease progression; this difference further affects the formulation of clinical prevention and treatment strategies, such as early warning screening for high-risk male groups and individualized corneal cross-linking intervention timing. This article reviews gender differences in keratoconus from the perspectives of epidemiology, clinical characteristics, prevention and treatment, and pathological mechanisms, providing relevant references and insights for future clinical practice.

OBJECTIVE: To explore the mechanism of acupuncture on improving ovarian hypofunction in aged rats from two perspectives: the overall regulation of the hypothalamic-pituitary-ovarian (HPO) axis and the local ovarian follicle stimulating hormone (FSH)/cyclic adenosine monophosphate (cAMP) signaling pathway. METHODS: Six 3-month-old female SPF-grade Sprague-Dawley (SD) rats were selected as the blank group. Another twelve 9-month-old female SD rats were randomly divided into a model group and an acupuncture group, with six rats in each. The acupuncture group received acupuncture at "Baihui" (GV20), "Guanyuan" (CV4), and bilateral "Ciliao" (BL32) for 20 min per session, once every other day, for a total of 10 sessions. Vaginal smear tests were performed daily to observe the estrous cycle of the rats. Ovarian morphology was observed using HE staining, and follicles at various stages were counted. ELISA was used to detect levels of serum FSH, luteinizing hormone (LH), estradiol (E₂), anti-müllerian hormone (AMH), hypothalamic gonadotropin-releasing hormone (GnRH), pituitary FSH and LH, and ovarian cAMP. Immunohistochemistry and Western blot were used to detect the protein expression of ovarian cAMP protein kinase catalytic subunit, FSH receptor (FSHR), and P450. Real-time quantitative PCR was used to measure mRNA expression levels of FSHR and P450 in ovarian tissue. RESULTS: Compared with the blank group, the model group showed an increased rate of estrous cycle disorder (P<0.01), reduced granulosa cell layers with blurred boundaries and disordered arrangement, decreased numbers of developing follicles at all stages, and increased numbers of atretic follicles (P<0.01); the serum levels of FSH and LH were increased (P<0.01), while E₂ and AMH levels were decreased (P<0.01); the hypothalamic GnRH and pituitary FSH and LH levels were elevated (P<0.01), and ovarian cAMP level was decreased (P<0.01); the positive expression and protein expression of ovarian P450, cAMP protein kinase catalytic subunit, and FSHR were reduced (P<0.01), and ovarian FSHR and P450 mRNA expression was decreased (P<0.01). Compared with the model group, the acupuncture group showed a reduced rate of estrous cycle disorder (P<0.01), clear granulosa cell margins, increased numbers of primordial and secondary follicles, and decreased numbers of atretic follicles (P<0.01); the serum FSH and LH levels were decreased (P<0.01, P<0.05), while E₂ and AMH levels were increased (P<0.05, P<0.01); the hypothalamic GnRH and pituitary FSH and LH levels were decreased (P<0.01, P<0.05), and ovarian cAMP level was increased (P<0.01); the positive expression and protein expression of ovarian P450, cAMP protein kinase catalytic subunit, and FSHR were elevated (P<0.01), and ovarian FSHR and P450 mRNA expression was increased (P<0.01). CONCLUSION Acupuncture could delay ovarian hypofunction in aged rats, possibly through regulating the HPO axis and the FSH/cAMP signaling pathway.
Animals ; Female ; Rats ; Rats, Sprague-Dawley ; Follicle Stimulating Hormone/genetics* ; Acupuncture Therapy ; Ovary/metabolism* ; Signal Transduction ; Humans ; Cyclic AMP/metabolism* ; Hypothalamo-Hypophyseal System/metabolism* ; Aging/metabolism* ; Hypothalamus/metabolism* ; Pituitary Gland/metabolism* ; Gonadotropin-Releasing Hormone/metabolism*

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
Humans ; Consensus ; Orthodontics, Corrective/standards* ; Periodontal Diseases/complications* ; Tooth Movement Techniques/methods* ; Practice Guidelines as Topic

Objective To investigate the risk factors associated with onset of vertebrobasilar doli-choectasia(VBD)symptoms in elderly patients.Methods A retrospective study was conducted on 206 elderly VBD patients admitted in Chinese PLA General Hospital between July 2014 and July 2024.Based on the presence of VBD-related symptoms or not,they were divided into a symptom-atic group(112 cases)and an asymptomatic group(94 cases).All patients underwent cranial mag-netic resonance angiography(MRA)and MRI.And routine blood tests were performed and related indicators were detected,including following parameters:neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation(SII)index,total cholesterol(TC),low-density lipoprotein choles-terol(LDL-C),and C-reactive protein(CRP).Multivariate logistic regression analysis was per-formed to identify risk factors associated with symptomatic progression in elderly VBD patients.Results The symptomatic group showed significantly higher SII index and NLR,longer bilateral vertebral artery length,and larger proportion of elevated vertebral artery confluence when compared with the asymptomatic group(P＜0.05,P＜0.01).Significant differences were also observed be-tween the two groups in basilar artery height grade and proportion of basilar artery hyperintensity of vessel wall signal(BA-HVS,P＜0.01).Multivariate logistic regression analysis revealed that elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal were risk factors for symptomatic onset in elderly VBD patients.The risk of symptomatic onset in elderly VBD patients with elevated confluence of the vertebral artery was 2.143 times higher than in those without elevation(95％CI:1.144-4.013,P=0.017).Similarly,the risk in elderly VBD patients with high-grade basilar artery hyperintensity of vessel wall signal was 4.113 times higher than in those without such signal(95％CI:2.213-7.646,P=0.000).Conclusion Elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal may serve as clinical indicators for monitoring disease progression in elderly patients with VBD,thereby facilitating the optimization of clinical management strategies in the patients.

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Objective To investigate the risk factors associated with onset of vertebrobasilar doli-choectasia(VBD)symptoms in elderly patients.Methods A retrospective study was conducted on 206 elderly VBD patients admitted in Chinese PLA General Hospital between July 2014 and July 2024.Based on the presence of VBD-related symptoms or not,they were divided into a symptom-atic group(112 cases)and an asymptomatic group(94 cases).All patients underwent cranial mag-netic resonance angiography(MRA)and MRI.And routine blood tests were performed and related indicators were detected,including following parameters:neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation(SII)index,total cholesterol(TC),low-density lipoprotein choles-terol(LDL-C),and C-reactive protein(CRP).Multivariate logistic regression analysis was per-formed to identify risk factors associated with symptomatic progression in elderly VBD patients.Results The symptomatic group showed significantly higher SII index and NLR,longer bilateral vertebral artery length,and larger proportion of elevated vertebral artery confluence when compared with the asymptomatic group(P＜0.05,P＜0.01).Significant differences were also observed be-tween the two groups in basilar artery height grade and proportion of basilar artery hyperintensity of vessel wall signal(BA-HVS,P＜0.01).Multivariate logistic regression analysis revealed that elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal were risk factors for symptomatic onset in elderly VBD patients.The risk of symptomatic onset in elderly VBD patients with elevated confluence of the vertebral artery was 2.143 times higher than in those without elevation(95％CI:1.144-4.013,P=0.017).Similarly,the risk in elderly VBD patients with high-grade basilar artery hyperintensity of vessel wall signal was 4.113 times higher than in those without such signal(95％CI:2.213-7.646,P=0.000).Conclusion Elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal may serve as clinical indicators for monitoring disease progression in elderly patients with VBD,thereby facilitating the optimization of clinical management strategies in the patients.

Objective To elucidate the therapeutic mechanism of Qingxin Jieyu Granule(QXJYG)against atherosclerosis(AS)based on network pharmacology.Methods The major targets and pathways of QXJYG against AS were analyzed using network pharmacology.Rat models of AS established by high-fat feeding combined with intraperitoneal vitamin D3 injection were treated daily with normal saline,atorvastatin(13.15 mg/kg),or QXJYG at 0.99,1.98,and 3.96 g/kg for 8 weeks(n=6).Ultrasound and HE staining were used to assess the function and pathologies of the abdominal aorta.Blood lipids and serum levels of Ang II,ET-1,TXA2,PGI2,and ox-LDL of the rats were detected using an automatic biochemical analyzer or ELISA.The expressions of LOX-1,PPARγ,RXRα,p-P65,VCAM-1 and ICAM-1 in the abdominal aorta were detected with immunohistochemistry.Results The rat models of AS showed obvious abdominal aorta wall thickening,increased pulse wave velocity and pulse index,decreased inner diameter of the abdominal aorta,elevated levels of TC,LDL-C,Ang II,ET-1 and TXA2,and lowered levels of HDL-C and PGI2.QXJYG and atorvastatin treatment of the rat models significantly alleviated histopathological changes of the abdominal aorta,decreased serum levels of TC,LDL-C,Ang II,ET-1 and TXA2,and increased the levels of HDL-C and PGI2.Network pharmacology study suggested the therapeutic effect of QXJYG against AS was mediated by regulating lipid metabolism,PPAR and NF-κB pathways.Consistently,treatments with QXJYG were found to significantly decrease ox-LDL level and LOX-1,P-P65,VCAM-1 and ICAM-1 protein expressions while increasing PPARγ and RXRα expressions in the aorta of AS rats.Conclusion QXJYG alleviates lipid metabolism disorder and improves histopathological changes of the abdominal aorta of AS rats possibly by lowering ox-LDL level,reducing LOX-1 expression,activating PPARγ and RXRα,and inhibiting P65 phosphorylation to reduce VCAM-1 and ICAM-1 expression in the aorta.

Background Improper settings of outdoor smoking points in public places may increase the risk of secondhand smoke exposure among the population. Conducting research on air pollution in and around smoking spots and related influencing factors can provide valuable insights for optimizing the setting of outdoor smoking points. Objective To investigate the influence of the number of smokers at outdoor smoking points and the distance on the diffusion characteristics of surrounding air pollutants, in order to optimize the setting of outdoor smoking points. Methods Surrounding the exhibition halls in the China International Import Expo (CIIE), two outdoor smoking points were randomly selected, one on the first floor (ground level) and the other on the second floor (16 m above ground), respectively. At 0, 3, 6, and 9 m from the smoking points in the same direction, validated portable air pollutant monitors were used to measure the real-time fine particulate matter (PM_2.5) and carbon dioxide (CO₂) concentrations for consecutive 5 d during the exhibition, as well as the environmental meteorological factors at 0 m with weather meters including wind speed, wind direction, and air pressure. An open outdoor atmospheric background sampling point was selected on each of the two floors to carry out parallel sampling. Simultaneously, the number of smokers at each smoking point were double recorded per minute. The relationships between the number of smokers, distance from the smoking points, and ambient PM_2.5 and CO₂ concentrations were evaluated by generalized additive regression models for time-series data after adjustment of confounders such as temperature, relative humidity, and wind speed. Results The median numbers of smokers at smoking points on the first and second floors were 6 [interquartile range (IQR): 3, 9] and 9 (IQR: 6, 13), respectively. Windless (wind speed <0.6 m·s⁻¹) occupied most of the time (85.9%) at both locations. The average concentration of ambient PM_2.5 at the smoking points (0 m) [mean ± standard deviation, (106±114) μg·m⁻³] was 4.2 times higher than that of the atmospheric background [(25±7) μg·m⁻³], the PM_2.5 concentration showed a gradient decline with the increase of distance from the smoking points, and the average PM_2.5 concentration at 9 m points [(35±22) μg·m⁻³] was close to the background level (1.4 times higher). The maximum concentration of CO₂ [(628±23) μmol·mol⁻¹] was observed at 0 m, and its average value was 1.3 times higher than that of the atmospheric background [(481±40) μmol·mol⁻¹], and there was no gradient decrease in CO₂ concentration with increasing distance at 0, 3, 6, and 9 m points. The regression analyses showed that, taking smoking point as the reference, every 3 m increase in distance was associated with a decrease of ambient PM_2.5 by 24.6 [95% confidence interval (95%CI): 23.5, 25.8] μg·m⁻³ (23.2%) and CO₂ by 54.1 (95%CI: 53.1, 55.1) μmol·mol⁻¹ (8.6%). Every one extra smoker at the smoking point was associated with an average increase of PM_2.5 and CO₂ by 2.0 (95%CI: 1.7, 2.8) μg·m⁻³ and 1.0 (95%CI: 0.7，1.2) μmol·mol⁻¹, respectively. The sensitivity analysis indicated that, under windless conditions, the concentrations of PM_2.5 and CO₂ at the smoking points were even higher but the decreasing and dispersion characteristics remained consistent. Conclusion Outdoor smoking points could significantly increase the PM_2.5 concentrations in the surrounding air and the risks of secondhand smoke exposure, despite of the noticeable decreasing trend with increasing distance. Considering the inevitable poor dispersion conditions such as windless and light wind, outdoor smoking points are recommended to be set at least 9 m or farther away from non-smoking areas.

BACKGROUND:Human plantar pressure can reflect the health status of the lower limbs and even the whole body,which is an important basis for gait analysis,and body mass index is an important influencing factor. OBJECTIVE:To investigate the effect of body mass index on plantar pressure. METHODS:Twenty young college students from Xuzhou Medical University,including 10 males and 10 females aged 19-21 years,were selected as test subjects and divided into three groups according to the body mass index value:overweight group(body mass index>25 kg/m2,n=3),lean group(body mass index<18 kg/m2,n=4),and normal group(body mass index 18-25 kg/m2,n=13).A natural walking gait test was carried out on the three groups of subjects with a Zebris pressure distribution measurement plate to obtain the complete gait cycle parameters.The time proportion of support time phase,peak pressure,time to peak force,peak force and impulse volume were analyzed and the correlation between each parameter and the body mass index was analyzed by Person analysis. RESULTS AND CONCLUSION:(1)Compared with the other two groups,the time proportion of support time phase of subjects in the overweight group was relatively small,while the time proportion in the foot heel contact period and forefoot extension period was relatively large.There was a positive correlation of the time proportion of the foot heel contact period and forefoot extension period with body mass index,while there was a negative correlation between the time proportion of the arch support period and body mass index.(2)The peak pressure of the left arch and palm of the foot of the subjects of the overweight group was higher than that of the normal group,and the peak pressure of the left and right palm of the foot of the lean group was lower than that of the normal group.The peak pressure was positively correlated with the body mass index during the foot heel contact period.There was a significant positive correlation between the peak pressure of the left foot and body mass index during the arch support period as well as the peak pressure of both feet and body mass index during the forefoot extension period.(3)Plantar peak force time in the order of the gait cycle in increasing order:heeltoe/middle 2-4 metatarsal>lateral heel>medial and lateral metatarsal>arch;medial heel peak force was the largest,and the arch peak force was the smallest.Except for the toe of the left foot,there was a significant positive correlation between peak force and body mass index.(5)The maximum ground impulse of the lean group and the overweight group was in the foot heel contact stage,the minimum ground impulse was in the forefoot extension period,and the minimum ground impulse of the arch was in the normal group.There was a significant positive correlation between ground impulse and body mass index at different periods.(6)The results show that young people should control their body mass index,wear appropriate shoes,protect their feet and ankles,and prevent the occurrence of flat feet.