Objective:To apply multifunctional debridement machine in burn wounds and complicated skin ulcers of wound surgery on the basis of its convenience in application,and analyze its application value.Methods:The multi-functional debridement machine realized the design of hardware system,the design of intelligent handle,the design of frequency tracking system and other integration design,so as to deal with wound quickly and accurately.A total of 156 patients with burn wounds and complicated skin ulcers who admitted to West Branch of Qingdao Municipal Hospital from January 2022 to January 2024 were selected,and they were divided into control group(78 cases)and observation group(78 cases)by random number method.Patients in the control group were treated by using the mode with bedhead and bedside debridement and dressing change every other day,while patients in the observation group were treated by multi-functional debridement machine.The effect was analyzed after treatment.Results:The healing rate of the observation group was 93.59%,which was significantly higher than that of the control group(73.08%)(x2=11.815,P＜0.05),and the healing time of the observation group was significantly shorter than that of the control group,and the difference was statistically significant(t=10.701,P＜0.05).The scores of wound depth,range of wound injury and degree of tissue necrosis in the observation group were lower than those in the control group,and the score of growth speed of granulation tissue was significantly higher than that in the control group,and the differences were statistical significance(t=5.617,7.993,4.781,5.133,P＜0.05).The pain scores on 1st day,7th day and 14th day after dressing change in the observation group were all lower than those in the control group,and the differences were statistical significance(t=19.898,11.801,10.191,P＜0.05).The sterilization rates of wound on the 3rd day,7th day and 10th day after treatment in the observation group were all higher than these in the control group,and the differences were statistical significance(t=15.168,13.476,6.785,P＜0.05).Conclusion:The hardware system of multifunctional debridement machine has large output power,high efficiency and obvious debridement effect.It has significant advantages in the treatment of burn wounds and complicated skin ulcers of wound surgery,which can relieve the degree of wound pain,and improve the cleaning effect and promote rapid recovery of wound.

AIM: To analyze the reasons and clinical outcomes of intraocular lens(IOL)exchange.METHODS:This retrospective case series study included 47 patients(53 eyes)who underwent IOL exchange surgery at the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, between April 2020 and May 2024, aged from 5 to 87(44.8±3.6)years old. Patients' demographics, surgical indications, surgical techniques, preoperative and postoperative uncorrected visual acuity(UCVA)and best-corrected visual acuity(BCVA), as well as postoperative complications were recorded.RESULTS:The reasons for IOL exchange included refractive error(18 cases, 23 eyes, 43%), IOL dislocation(12 cases, 13 eyes, 25%), IOL opacification(12 cases, 12 eyes, 23%), neuroadaptation failure(3 cases, 3 eyes, 6%), and patient dissatisfaction with visual quality(2 cases, 2 eyes, 4%). The surgical techniques for IOL exchange included in-the-bag IOL fixation(16 eyes, 30%), ciliary sulcus fixation(27 eyes, 51%), and scleral suture fixation(10 eyes, 19%). There was statistical significant difference between preoperative UCVA(LogMAR)and UCVA(LogMAR)at 1 d postoperatively(1.03±0.64 vs 0.50±0.46, P<0.05), and there was statistical significant difference between preoperative BCVA(LogMAR)and BCVA(LogMAR)at 1 mo postoperatively(0.41±0.37 vs 0.17±0.21, P<0.05). Postoperative complications included posterior capsule opacification in 2 eyes and IOL dislocation in 1 eye.CONCLUSION:Refractive error, IOL dislocation, and IOL opacification were the three most common reasons for IOL exchange. Although less frequent, factors such as neuroadaptation issues associated with multifocal IOLs and patient-reported visual quality dissatisfaction reflect growing expectations for improved visual outcomes. IOL exchange surgery, though technically challenging, demonstrates favorable clinical efficacy and a low complication rate, representing an effective intervention for managing postoperative IOL-related issues following cataract surgery.

Objective To analyze the association between relative fat mass index(RFM)and the risk of gallstones in adults.Methods Adult participants from the National Health and Nutrition Examination Survey(NHANES)were included.RFM was calculated based on the participants'height and waist circumference.The history of gallstone disease was obtained through self-reports.The relationship between RFM and the risk of gallstones was assessed using Logistic regression analy-sis,smooth curve fitting and subgroup analysis.Results A total of 4,874 participants were includ-ed in the study.The RFM level of gallstone subjects was significantly higher than that of non-gallstone subjects(P＜0.001).After adjusting for various confounders,RFM level was found to be independ-ently associated with the risk of gallstones(OR=1.095,95％CI:1.022 to 1.173,P=0.010).Smooth curve fitting analysis indicated that the risk of gallstone disease also increased as RFM levels increased.The results of subgroup analysis showed no significant differences in the relationship be-tween RFM and gallstones across different populations.Conclusion Higher RFM level is associated with an increased risk of gallstones in participants.RFM may serve as an economical,effective and convenient indicator for assessing the risk of gallstones,but further prospective studies are required to validate these findings.

Objective To explore the application value of improving the operation method of the coaxial microcatheter system to increase the recanalization rate of long-segment occluded blood vessels in the lower extremity arteries.Methods Eleven patients with long-segment occlusion of the lower extremity arteries were selected.Firstly,the angiographic catheter was sent to about 3-4 cm proximal to the occluded segment to provide support and direction control of the coaxial microcatheter system.Then,the microcathe-ter was sent to about 1 cm proximal to the occluded segment through the angiographic catheter,and the microguide wire was sent to the occluded segment,making the tip of the guide wire closely adhere to the occluded segment.The guide wire was fixed by using the guide wire controller to ensure that the guide wire in the blood vessel was always about 1 cm exposed outside the microcatheter.Meanwhile,the microcatheter and the microguide wire were rotated to make the tip form a"spring"shape similar to that of a pipe-line dredging machine,so that the coaxial microcatheter system could pass through the occluded segment of the blood vessel in this shape.After confirmed that the microcatheter had entered the lumen of the distal outflow tract blood vessel,the subsequent interven-tional treatment was completed according to the conventional method.Results Eleven patients with long-segment occluded blood vessels in the lower extremity arteries were successfully treated with improving the operation method of the coaxial microcatheter system to dredge the occluded segment,and completed the interventional treatment of the affected limb blood vessels without vascu-lar rupture,vascular bleeding or arterial dissection.Conclusion Using the improved operation method of the coaxial microcatheter system to dredge the long-segment occluded blood vessels of the lower extremity arteries is simple,safe and has a high success rate,which is worthy of clinical promotion.

Objective To explore the application value of improving the operation method of the coaxial microcatheter system to increase the recanalization rate of long-segment occluded blood vessels in the lower extremity arteries.Methods Eleven patients with long-segment occlusion of the lower extremity arteries were selected.Firstly,the angiographic catheter was sent to about 3-4 cm proximal to the occluded segment to provide support and direction control of the coaxial microcatheter system.Then,the microcathe-ter was sent to about 1 cm proximal to the occluded segment through the angiographic catheter,and the microguide wire was sent to the occluded segment,making the tip of the guide wire closely adhere to the occluded segment.The guide wire was fixed by using the guide wire controller to ensure that the guide wire in the blood vessel was always about 1 cm exposed outside the microcatheter.Meanwhile,the microcatheter and the microguide wire were rotated to make the tip form a"spring"shape similar to that of a pipe-line dredging machine,so that the coaxial microcatheter system could pass through the occluded segment of the blood vessel in this shape.After confirmed that the microcatheter had entered the lumen of the distal outflow tract blood vessel,the subsequent interven-tional treatment was completed according to the conventional method.Results Eleven patients with long-segment occluded blood vessels in the lower extremity arteries were successfully treated with improving the operation method of the coaxial microcatheter system to dredge the occluded segment,and completed the interventional treatment of the affected limb blood vessels without vascu-lar rupture,vascular bleeding or arterial dissection.Conclusion Using the improved operation method of the coaxial microcatheter system to dredge the long-segment occluded blood vessels of the lower extremity arteries is simple,safe and has a high success rate,which is worthy of clinical promotion.

Objective:To apply multifunctional debridement machine in burn wounds and complicated skin ulcers of wound surgery on the basis of its convenience in application,and analyze its application value.Methods:The multi-functional debridement machine realized the design of hardware system,the design of intelligent handle,the design of frequency tracking system and other integration design,so as to deal with wound quickly and accurately.A total of 156 patients with burn wounds and complicated skin ulcers who admitted to West Branch of Qingdao Municipal Hospital from January 2022 to January 2024 were selected,and they were divided into control group(78 cases)and observation group(78 cases)by random number method.Patients in the control group were treated by using the mode with bedhead and bedside debridement and dressing change every other day,while patients in the observation group were treated by multi-functional debridement machine.The effect was analyzed after treatment.Results:The healing rate of the observation group was 93.59%,which was significantly higher than that of the control group(73.08%)(x2=11.815,P＜0.05),and the healing time of the observation group was significantly shorter than that of the control group,and the difference was statistically significant(t=10.701,P＜0.05).The scores of wound depth,range of wound injury and degree of tissue necrosis in the observation group were lower than those in the control group,and the score of growth speed of granulation tissue was significantly higher than that in the control group,and the differences were statistical significance(t=5.617,7.993,4.781,5.133,P＜0.05).The pain scores on 1st day,7th day and 14th day after dressing change in the observation group were all lower than those in the control group,and the differences were statistical significance(t=19.898,11.801,10.191,P＜0.05).The sterilization rates of wound on the 3rd day,7th day and 10th day after treatment in the observation group were all higher than these in the control group,and the differences were statistical significance(t=15.168,13.476,6.785,P＜0.05).Conclusion:The hardware system of multifunctional debridement machine has large output power,high efficiency and obvious debridement effect.It has significant advantages in the treatment of burn wounds and complicated skin ulcers of wound surgery,which can relieve the degree of wound pain,and improve the cleaning effect and promote rapid recovery of wound.

Objective To investigate the effect of the protein kinase RNA-like endoplasmic reticulum kinase(PERK)/eukaryotic initiation factor 2α(eIF2α)pathway in endoplasmic reticulum stress on the activation of hepatic stellate cells(HSC).Methods Pathological sections of normal liver tissue after surgery were collected from 11 patients with hepatic fibrosis(S1-S4)and 9 patients with hepatic hemangioma and hepatic adenoma confirmed by liver biopsy,and immunohistochemistry was used to measure the protein expression levels of PERK,eIF2α,and C/EBP homologous protein(CHOP).Human HSC-LX2 cells were treated with different concentrations of the endoplasmic reticulum stress inducer thapsigargin(0,125,250,500,and 1 000 nmol/L),and qRT-PCR was used to measure the mRNA expression level of PERK,while Western blot was used to measure the protein expression levels of PERK,inositol requiring protein 1(IRE1),activating transcription factor 6(ATF6),CHOP,and α-smooth muscle actin(α-SMA).The method of lentivirus transfection was used to construct a PERK stable overexpression LX-2 group and a control group;qRT-PCR was used to measure the mRNA expression levels of PERK,eIF2α,and α-SMA,Western blot was used to measure the protein expression levels of PERK,phosphorylated eIF2α(p-eIF2α),and α-SMA,and immunofluorescence assay was used to measure the expression of collagen type Ⅰ alpha 1(COL1A1).The independent samples t-test was used for comparison of normally distributed continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.Results Compared with normal liver tissue,the liver tissue of patients with hepatic fibrosis had significantly higher expression levels of PERK,eIF2α,and CHOP(Z=-3.56,t=-5.75,Z=-3.52,all P<0.001).Compared with the solvent group,the groups treated with different concentrations of thapsigargin had significant increases in the expression levels of the endoplasmic reticulum-associated proteins PERK,CHOP,IRE1,ATF6,and α-SMA(all P<0.05).Compared with the control group,the PERK stable overexpression group had significant increases in the mRNA expression levels of PERK,eIF2α,and α-SMA and the protein expression levels of PERK,p-eIF2α,and α-SMA(all P<0.05),and immunofluorescence assay showed a significant increase in the expression level of COL1A1 in the PERK stable overexpression group(P<0.05).Conclusion PERK overexpression can induce the expression of α-SMA and COL1A1 in LX-2 cells,suggesting that the PERK signaling pathway might be one of the important mechanisms of HSC activation.

Objective:To observe the correlation between retinal capillary density and retinal thickness in the macula and spherical equivalent (SE) in school-age children.Methods:A cross-sectional study. From May to December 2022, 182 school-age children who visited the ophthalmology department of the First Affiliated Hospital of Zhengzhou University were included. There were 95 males and 87 females. The age ranged from 6 to 12 years, and the spherical equivalent (SE) was +0.50 to -6.00 D. They were divided into three groups based on the SE of the right eyes: 54 eyes in emmetropia group (+0.50≤SE<-0.50 D), 71 eyes in low myopia group (-0.50≤SE<-3.00 D), and 57 eyes in moderate myopia group (-3.00≤SE≤-6.00 D). The macular area of 6 mm×6 mm was scanned using swept-source optical coherence tomography angiography and was divided into three concentric rings centered on the fovea, including the macular central fovea (0-1 mm diameter), inner ring (1-3 mm diameter) and outer ring (3-6 mm diameter). The retinal thickness and blood flow density of superficial vascular plexus (SVP) and deep vascular plexus (DVP) in different zones within 6 mm of the macular area were measured. The relationships between SE and SVP, DVP and retinal thickness in each ring region were investigated by univariate and multivariate linear regression analyses, smooth curve fitting, and threshold effects.Results:There were significant differences in the SVP ( F=6.64, 26.06, 22.69) and DVP ( F=7.97, 25.01, 5.09) of macular central fovea, inner ring and outer ring among the emmetropia, low myopia and moderate myopia groups ( P<0.05). Univariate linear regression analysis showed that the SVP ( β=-0.56,-1.17, -0.79) and DVP ( β=-1.03, -0.93, -0.45) of the three regions were positively correlated with SE ( P<0.05). After smooth curve fitting, threshold effect analysis and multivariate linear regression analysis, the SVP and DVP in the macular central fovea were linearly positively correlated with SE ( β=-0.91, -1.40; P<0.05), and SVP and DVP in the inner ring and outer ring showed an inverted U-shaped curve relationship with SE with the inflection (<3.00 D). When the SE was less than <3.00 D, the SVP and DVP in the inner ring and outer ring were positively correlated with SE ( P<0.05). When the SE was higher than -3.00 D, except for the DVP in the inner ring region, the other parameters were negatively correlated with SE ( P<0.05). There were significant differences in retinal thickness of the inner ring and outer ring ( F=5.47, 16.36; P<0.05), and no significant difference in the macular central fovea among the emmetropia, low and moderate myopia groups ( F=2.16, P>0.05). By using univariate and multivariate linear regression analyses, the retinal thickness in the inner ring and outer ring were negatively correlated with SE ( β =1.99, 3.05; P<0.05). However, no correlation was found between retinal thickness and SE in the macular central fovea ( β=-1.65, P>0.05). Conclusions:In school-age children with SE between +0.50 D and -6.00 D, the retinal capillaries density of the macular central fovea gradually increase, and increase first and then decrease in the inner ring and outer ring with increasing SE. The retinal thickness of inner ring and outer ring gradually decrease and not change significantly in the macular central fovea.

The initiative and enthusiasm of medical staff in teaching work are the sources of improving the quality of clin-ical teaching.Stimulating the teaching enthusiasm of clinical teachers is an important connotation of the sustainable and high-quality development of teaching hospital.This article aims to establish a point-based teaching performance evaluation system to evaluate clinical teachers,stimulate the enthusiasm of medical staff to participate in clinical teaching activities,and promote clin-ical standardization through teaching.

Objective:To investigate the relationship between serum interleukin-6 and interleukin-10 levels and clinical prognosis in patients with severe acute pancreatitis.Methods:Ninety-two patients with severe acute pancreatitis who received treatment in The Second People's Hospital of Liaocheng from August 2018 to July 2021 were included in this study. Serum interleukin (IL)-6 and IL-10 levels were detected. The Bedside Index of Severity in Acute Pancreatitis (BISAP) score was evaluated. Clinical interventions were performed. The relationship between serum IL-6 and IL-10 levels and the clinical prognosis of severe acute pancreatitis was investigated.Results:Serum IL-6 level [(103.75 ± 15.53) ng/L] was highest in patients who died. Serum IL-10 level [(97.33 ± 13.06) ng/L] was highest in patients with local complications. The highest number of patients with a prognostic outcome of death [26 (37.14%)] was found in patients with a BISAP score ≥ 3. Serum IL-6 level in patients with severe acute pancreatitis was positively correlated with the BISAP score ( r = 0.62, P < 0.05), and serum IL-6 level and BISAP score were negatively correlated with serum IL-10 level ( r = -0.57, -0.61, both P < 0.05). Conclusion:Increased or decreased serum IL-6 and IL-10 levels in patients with severe acute pancreatitis indicate that the patient's condition tends to worsen, and timely intervention according to serum IL-6 and IL-10 levels can improve the clinical prognosis of severe acute pancreatitis.