AIM: To investigate the abnormal conditions and change patterns of accommodative facility in patients with different refractive states before and after small incision lenticule extraction(SMILE)surgery.METHODS:A prospective clinical cohort study was conducted. A total of 59 patients(118 eyes)who underwent SMILE surgery and had visual function files established in our hospital from June to December 2023 were randomly selected, including 37 males and 22 females, aged 18-35 years(with an average age of 25.19±5.65 years). According to the preoperative spherical equivalent(SE), they were divided into two groups: the low-to-moderate myopia group(SE≥-6.00 DS)with 40 patients(80 eyes), and the high myopia group(SE<-6.00 DS)with 19 patients(38 eyes). The monocular and binocular accommodative facility before surgery and at 1 wk and 1 mo after surgery were compared, and the changes in accommodative facility before and after SMILE surgery in the two groups of patients were analyzed.RESULTS:All surgeries were completed successfully. In the low-to-moderate myopia group, 33 cases(66 eyes)completed the 1-month follow-up after surgery, with a loss to follow-up rate of 17.5%(7/40). In the high myopia group, 15 patients(30 eyes)completed the 1-month follow-up after surgery, with a loss to follow-up rate of 21.1%(4/19). After SMILE surgery, the uncorrected visual acuity and SE of both low-to-moderate myopia and high myopia were significantly improved(all P<0.05). The accommodative facility of the right eyes in all the patients at 1 mo after surgery was better than that before surgery and at 1 wk after surgery(P=0.002, 0.006), the accommodative facility of the left eyes was significantly increased at 1 mo after surgery than that at 1 wk after surgery(P=0.005), and the binocular accommodative facility at 1 mo after surgery was significantly increased compared with that before surgery(P<0.017). Furthermore, there were statistical significance in accommodative facility of the right eyes in the low-to-moderate group at 1 mo compared with that before surgery and at 1 wk after surgery(P=0.011, 0.004); it was significantly increased in the left eyes at 1 mo after surgery compared with that at 1 wk after surgery(P=0.001), and binocular accommodative facility at 1 mo after surgery was significantly better than that before surgery(P<0.001). Furthermore, there was no statistical significance in the right, left and binocular accommodative facility of patients in the high myopia group(all P>0.017).CONCLUSION: After SMILE surgery, the monocular accommodative facility shows a transient decrease and then exceeds the preoperative level at 1 mo after surgery, and the binocular accommodative facility gradually improves after surgery. SMILE surgery has a positive impact on the monocular and binocular accommodative facility in patients with low-to-moderate myopia, but has no significant impact on the accommodative facility in patients with high myopia. It is of clinical significance to strengthen the detection of monocular and binocular accommodative facility before and after SMILE surgery.

Objective:To explore clinical characteristics of adverse drug reactions of novel antineoplastic drugs in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS).Methods:The study was a retrospective case-control design. The subjects were selected from patients who used novel antineoplastic drugs in Henan Provincial Infectious Disease Hospital from January 1 to December 31, 2023. Clinical data of patients were collected through the hospital electronic medical record system. Adverse reactions of novel antineoplastic drugs were screened and the incidence was calculated. According to results of HIV antibody testing, adverse reaction incidence was compared between HIV antibody-negative and-positive patients. Then the patients with HIV/AIDS were divided into 2 groups according to whether adverse reactions occurred and the differences in clinical data between them were compared; the clinical manifestations, intervention and outcomes of adverse reactions were analyzed descriptively.Results:A total of 182 patients were enrolled in this study, the overall incidence rate of adverse reactions of novel antineoplastic drugs was 56.6% (103/182), and the incidences in HIV antibody-positive and -negative patients were 55.9% (76/136) and 58.7% (27/46), respectively, with no statistically significant difference ( P>0.05). In patients with HIV/AIDS, the proportions of patients over 50 years old [80.3% (61/76) vs. 63.3% (38/60)], with a history of previous adverse reactions [43.4% (33/76) vs. 23.3% (14/60)], and with other comorbidities [57.9% (44/76) vs. 40.0% (24/60)] in the adverse reactions group were higher than those in the non-adverse reactions group, and the differences were all statistical significance (all P<0.05). No statistically significant differences were found in gender, CD4 + T lymphocyte levels, HIV viral load, antiretroviral treatment regimens, and tumor types between the 2 groups (all P>0.05). Adverse reactions occurred for 91 times in the 76 patients, 27 (29.7%) of which were grade 1, 45 (49.4%) were grade 2, and 19 (20.9%) were grade 3 or severer. According to clinical characteristics, there were 209 performances of adverse reactions in 76 patients, mainly including hand-foot syndrome, fatigue, hypertension, rash, etc., with the main affected system and organs being the skin and its appendages and the gastrointestinal system. The involved drugs mainly were anlotinib (44 cases, 21.0%), lenvatinib (29 cases, 13.9%), and bevacizumab (23 cases, 11.0%). After drug adjustments and symptomatic treatments, 80 times of adverse reactions were eventually improved, 4 were not, and 3 were with unknown information. Conclusions:The incidences of adverse reactions of novel antineoplastic drugs were similar between patients with and without HIV/AIDS. In HIV/AIDS patients with tumors, those over 50 years old, with other diseases, and with a history of adverse reactions might have higher risks of adverse reactions, which mainly involved the skin and its appendages and the gastrointestinal system, with a severity of mostly grade 1 to 2. With timely managements, the prognosis was favorable.

Objective:To explore clinical characteristics of adverse drug reactions of novel antineoplastic drugs in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS).Methods:The study was a retrospective case-control design. The subjects were selected from patients who used novel antineoplastic drugs in Henan Provincial Infectious Disease Hospital from January 1 to December 31, 2023. Clinical data of patients were collected through the hospital electronic medical record system. Adverse reactions of novel antineoplastic drugs were screened and the incidence was calculated. According to results of HIV antibody testing, adverse reaction incidence was compared between HIV antibody-negative and-positive patients. Then the patients with HIV/AIDS were divided into 2 groups according to whether adverse reactions occurred and the differences in clinical data between them were compared; the clinical manifestations, intervention and outcomes of adverse reactions were analyzed descriptively.Results:A total of 182 patients were enrolled in this study, the overall incidence rate of adverse reactions of novel antineoplastic drugs was 56.6% (103/182), and the incidences in HIV antibody-positive and -negative patients were 55.9% (76/136) and 58.7% (27/46), respectively, with no statistically significant difference ( P>0.05). In patients with HIV/AIDS, the proportions of patients over 50 years old [80.3% (61/76) vs. 63.3% (38/60)], with a history of previous adverse reactions [43.4% (33/76) vs. 23.3% (14/60)], and with other comorbidities [57.9% (44/76) vs. 40.0% (24/60)] in the adverse reactions group were higher than those in the non-adverse reactions group, and the differences were all statistical significance (all P<0.05). No statistically significant differences were found in gender, CD4 + T lymphocyte levels, HIV viral load, antiretroviral treatment regimens, and tumor types between the 2 groups (all P>0.05). Adverse reactions occurred for 91 times in the 76 patients, 27 (29.7%) of which were grade 1, 45 (49.4%) were grade 2, and 19 (20.9%) were grade 3 or severer. According to clinical characteristics, there were 209 performances of adverse reactions in 76 patients, mainly including hand-foot syndrome, fatigue, hypertension, rash, etc., with the main affected system and organs being the skin and its appendages and the gastrointestinal system. The involved drugs mainly were anlotinib (44 cases, 21.0%), lenvatinib (29 cases, 13.9%), and bevacizumab (23 cases, 11.0%). After drug adjustments and symptomatic treatments, 80 times of adverse reactions were eventually improved, 4 were not, and 3 were with unknown information. Conclusions:The incidences of adverse reactions of novel antineoplastic drugs were similar between patients with and without HIV/AIDS. In HIV/AIDS patients with tumors, those over 50 years old, with other diseases, and with a history of adverse reactions might have higher risks of adverse reactions, which mainly involved the skin and its appendages and the gastrointestinal system, with a severity of mostly grade 1 to 2. With timely managements, the prognosis was favorable.

Objective To investigate the causal association of liver function and lipid metabolism levels with sleep disorders based on the Mendelian randomization analysis.Methods The analysis was conducted using the data from genome-wide association studies,with the exposure factors of liver function and lipid metabolism levels(alanine aminotransferase[ALT],aspartate aminotransferase[AST],gamma-glutamyl transpeptidase[GGT],albumin[Alb],serum total protein[TP],total bilirubin[TBil],alkaline phosphatase[ALP],triglyceride[TG],triglyceride-to-glycerol-3-phosphate[TG/G3P]ratio,total cholesterol[TC],high-density lipoprotein cholesterol[HDL-C],low-density lipoprotein cholesterol[LDL-C],poly-unsaturated fatty acids[PUFA],total fatty acids[TFA],PUFA/TFA ratio)and the outcome factor of sleep disorders(nonorganic).The regression models including inverse variance weighted,MR-Egger,Simple mode,weighted median,and Weighted mode were used to perform the Mendelian randomization analysis.Results Serum Alb(odds ratio[OR]=0.728,95%confidence interval[CI]:0.535-0.989,P＜0.05),HDL-C(OR=0.879,95%CI:0.784-0.986,P＜0.05),and PUFA/TFA ratio(OR=0.800,95%CI:0.642-0.998,P＜0.05)were negatively associated with sleep disorders,while TG/G3P ratio(OR=1.222,95%CI:1.044-1.431,P＜0.05)was positively associated with sleep disorders.The results of Mendelian randomization did not show a causal association of ALT,AST,GGT,TP,TBil,ALP,TG,TC,LDL-C,PUFA,and TFA with sleep disorders(all P＞0.05).The results of the MR-Egger intercept test showed no pleiotropy(P＞0.05),and Mendelian randomization was a valid method for causal inference in this study.Conclusion According to the results of the Mendelian randomization analysis,liver function and lipid metabolism show significant association with sleep disorders.Liver function and lipid metabolism can be used as indicators for predicting the risk of sleep disorders and performing intervention.

Objective:To explore the influencing factors of clinical pregnancy rate after single cleavage embryo transfer.Methods:A total of 2 764 patients who underwent single cleavage embryo transfer in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2017 to October 2021 were included in a retrospective cohort study, The clinical data and cycle outcomes were analyzed by using univariate and multivariate logistic regression to explore the independent influencing factors of clinical pregnancy.Results:Multivariate logistic regression analysis showed that age, ovulation stimulation protocol, antral follicle number, blastomere number, fragment ratio, endometrial thickness, elective single embryo transfer were independent influencing factors of clinical pregnancy rate (all P<0.05). The effect of blastomere number on clinical pregnancy rate ( OR=2.92, 95% CI: 1.58-5.39) was stronger than that of fragment ratio ( OR=0.73, 95% CI: 0.55-0.98). The results of further stratified analysis showed that when the number of embryo cells was 8, the clinical pregnancy rate of patients less than 35 years old was significantly increased regardless of whether the embryo fragment ratio was more than 10% or not ( OR=4.78, 95% CI: 3.06-7.47; OR=3.53, 95% CI: 1.85-6.76), while in patients ≥35 years old, when the fragment ratio of transferred embryos was less than 10%, the clinical pregnancy rate of 8-cell embryos was significantly higher than that of 4-6-cell embryos ( OR=3.58, 95% CI: 1.64-7.84). Conclusion:The blastomere number and fragment ratio are the main influencing factors of the clinical pregnancy rate of single cleavage embryo transfer in young patients and the former has a stronger correlation with the clinical pregnancy rate. The decrease of blastomere number of transferred embryos is related to the decrease of clinical pregnancy rate. Cleavage embryos with 8 cells and fragment ratio less than 10% should be preferred for transfer.

Objective:To explore the influencing factors of clinical pregnancy rate after single cleavage embryo transfer.Methods:A total of 2 764 patients who underwent single cleavage embryo transfer in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2017 to October 2021 were included in a retrospective cohort study, The clinical data and cycle outcomes were analyzed by using univariate and multivariate logistic regression to explore the independent influencing factors of clinical pregnancy.Results:Multivariate logistic regression analysis showed that age, ovulation stimulation protocol, antral follicle number, blastomere number, fragment ratio, endometrial thickness, elective single embryo transfer were independent influencing factors of clinical pregnancy rate (all P<0.05). The effect of blastomere number on clinical pregnancy rate ( OR=2.92, 95% CI: 1.58-5.39) was stronger than that of fragment ratio ( OR=0.73, 95% CI: 0.55-0.98). The results of further stratified analysis showed that when the number of embryo cells was 8, the clinical pregnancy rate of patients less than 35 years old was significantly increased regardless of whether the embryo fragment ratio was more than 10% or not ( OR=4.78, 95% CI: 3.06-7.47; OR=3.53, 95% CI: 1.85-6.76), while in patients ≥35 years old, when the fragment ratio of transferred embryos was less than 10%, the clinical pregnancy rate of 8-cell embryos was significantly higher than that of 4-6-cell embryos ( OR=3.58, 95% CI: 1.64-7.84). Conclusion:The blastomere number and fragment ratio are the main influencing factors of the clinical pregnancy rate of single cleavage embryo transfer in young patients and the former has a stronger correlation with the clinical pregnancy rate. The decrease of blastomere number of transferred embryos is related to the decrease of clinical pregnancy rate. Cleavage embryos with 8 cells and fragment ratio less than 10% should be preferred for transfer.

Activation of the heart normally begins in the sinoatrial node (SAN). Electrical impulses spontaneously released by SAN pacemaker cells (SANPCs) trigger the contraction of the heart. However, the cellular nature of SANPCs remains controversial. Here, we report that SANPCs exhibit glutamatergic neuron-like properties. By comparing the single-cell transcriptome of SANPCs with that of cells from primary visual cortex in mouse, we found that SANPCs co-clustered with cortical neurons. Tissue and cellular imaging confirmed that SANPCs contained key elements of glutamatergic neurotransmitter system, expressing genes encoding glutamate synthesis pathway (Gls), ionotropic and metabotropic glutamate receptors (Grina, Gria3, Grm1 and Grm5), and glutamate transporters (Slc17a7). SANPCs highly expressed cell markers of glutamatergic neurons (Snap25 and Slc17a7), whereas Gad1, a marker of GABAergic neurons, was negative. Functional studies revealed that inhibition of glutamate receptors or transporters reduced spontaneous pacing frequency of isolated SAN tissues and spontaneous Ca

Objective:To investigate the effect of artificial dermis combined with KCI negative pressure suction device in the repair of scalp defect with skull exposure after the operation of scalp malignancy.Methods:From January 2016 to June 2018, 18 patients with scalp defect and skull exposure after scalp malignant tumor surgery were treated with artificial dermis combined with KCI negative pressure suction device.Results:Eighten patients had good wound healing after the first stage of surgery, and no infection occurred. The time for artificial dermis to complete granulation was 10-14 days, with an average of 12.1 days. After the second stage of skin grafting, the skin graft had a survival rate of 100%, with uniform color and good elasticity, without obvious scar hyperplasia or contracture. The postoperative follow-up period was 6 to 2 months, all the patients healed well without tumor recurrence, with good skin elasticity and friction-resistant, and they were satisfied.Conclusions:Artificial dermis combined with KCI negative pressure suction device is an effective and simple method to repair the scalp defect with skull exposure after tumor surgery.

Objective:To provide health education based on the constitution identification, summarize the changes in the cardiovascular residual risk of the pre-diabetic population, so as to explore a new way to reduce the risk of cardiovascular disease in this population.Methods:From July 2016 to October 2017, convenience sampling was used to select 200 patients with prediabetes who were treated in 4 community centers in Chaoyang District, Beijing as the research object. The population was randomly divided into conventional health education group and constitution identification-based health education group, with 100 cases in each group. Conventional health education group carried out conventional health education. Constitution identification-based health education group used the "Classification and Determination of Constitution in TCM" to identify the constitution, and conduct health education of Traditional Chinese Medicine for the constitution. The high-density lipoprotein (HDL) , low-density lipoprotein (LDL) , triglycerides (TG) , total cholesterol (TC) and blood uric acid (UA) were compared between the two groups before and after the intervention.Results:Before the intervention, there was no significant difference in HDL-C, LDL-C, TG, TC and UA between the two groups ( P>0.05) . After the intervention, the LDL-C of the constitution identification-based health education group was higher than that of the conventional health education group, and the TG and UA were lower than those of the conventional health education group, and the difference was not statistically significant ( P>0.05) . The HDL of the constitution identification-based health education group was higher than that of the conventional health education group, and the TC was lower than that of the conventional education group, the difference was statistically significant ( P<0.05) . Conclusions:Health education based on the constitution identification can effectively reduce the cardiovascular residual risk of pre-diabetes population, and it is a new way to reduce the risk of cardiovascular disease in this population.

Objective:To evaluate the therapeutic effects and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.Methods:The clinical data of a total of 148 patients with locally advanced esophageal squamous cell carcinoma enrolled in the Affiliated Cancer Hospital of Zhengzhou University from 2007 to 2017 were retrospectively analyzed. The patients received 5-Fu/Cisplatin or Paclitaxel/Cisplatin for chemotherapies. The total treatment dose for the radiotherapy was delivered at 36-40Gy under conventional fractionation. Kaplan-Meier method was used to calculate survival rates, and Log-rank test and Cox model were performed for univariate analysis and multivariate analysis, respectively.Results:The overall survival (OS) rates of 1-, 3-and 5-year were 74%, 51% and 51%, respectively, with a median survival time (MST) of 72.4 months. The carcinoma/disease-free survival (DFS) rates for 1, 3, 5 years were 60%, 51%, 45%, respectively, with a median time of 60.1 months. The 1-, 3-and 5-year OS rates of the pCR group were 86%, 70%, 70%, the ones of which in the non-pCR group were 70%, 44%, 43%, respectively ( P=0.002). The 1-, 3-and 5-year DFS rates were 76%, 71%, 68% for the pCR group, and 53%, 43%, 37% for the non-pCR group, respectively ( P=0.002). In pN(-) group and pN(+ ) group, the 1-, 3-and 5-year OS rates were 83%, 56%, 55% and 50%, 38%, 38%( P=0.004), respectively. Further, the 1-, 3-and 5-year DFS rates were 66%, 56%, 51% for the pN(-) group, and 43%, 38%, 31% for the pN(+ ) group ( P=0.006), respectively. Multivariate analysis revealed that pCR and pN status were independent prognostic factors for OS and DFS ( P=0.012, 0.011 and P=0.025, 0.033). Conclusion:Neoadjuvant chemoradiotherapy demonstrated significant therapeutic effects in the treatment of locally advanced esophageal squamous cell carcinoma, while pCR and pN status served as independent prognostic factors.