AIM: To compare the effects of different nucleus chopping methods on the central corneal thickness, corneal endothelial cell(CEC)count and tear inflammatory indicators in patients with hard nucleus cataract.METHODS: Retrospective study. Totally 89 patients(89 eyes)with hard nucleus cataract who treated in our hospital were included from January 2020 to December 2022. According to different intraoperative nucleus chopping methods, the patients were divided into reverse prechop group(46 eyes)and phaco-chop group(43 eyes). The total effective rate of surgery and visual acuity recovery were compared between the two groups. Corneal related indicators(central corneal thickness, CEC count, CEC area), tear inflammatory indicators and tear film function [tear film break-up time(BUT), Chinese Dry Eye Questionnaire(CDEQ), Schirmer Ⅰ test(SⅠt)] were observed before and after surgery in both groups, and the degree of corneal edema was evaluated.RESULTS: The effective phaco time, phaco energy and cumulative complex energy parameters in the phaco-chop group were longer or higher than those in the reverse prechop group(P<0.05). The macular retinal thickness in the reverse prechop group at 7 d and 1 mo after surgery was thinner than that in the phaco-chop group, the central corneal thickness at 3 and 7 d after surgery was also thinner than that in the phaco-chop group, the CEC count at 3 mo after surgery was more than that in the phaco-chop group, the CEC loss rate was lower than that in the phaco-chop group, and the CEC area at 3 mo after surgery was smaller than that in the phaco-chop group(P<0.05). The levels of tear TNF-α and IL-6 at 7 d and 1 mo after surgery in the reverse prechop group were lower than those in the phaco-chop group(P<0.05). The BUT at 1 and 3 mo after surgery was longer in the reverse prechop group than that in the phaco-chop group(P<0.05). The CDEQ score in the reverse prechop group was lower than that in the phaco-chop group at 1 and 3 mo after surgery(P<0.05). The SⅠt at 1 and 3 mo after surgery was higher in the reverse prechop group compared with that in the phaco-chop group(P<0.05). The degree of corneal edema at 1 d after surgery was milder in the reverse prechop group than that in the phaco-chop group(P<0.05). CONCLUSION: Compared with phaco-chop, the application of reverse-chopper prechop combined with phacoemulsification can better reduce the ultrasonic energy in the treatment of hard nuclear cataract, and it is more conducive to reducing the postoperative inflammatory degree, improving the tear film function and relieving the corneal edema degree.

AIM: To investigate the efficacy of small-incision horizontal space nuclear splitting surgery and phacoemulsification combined with regional refractive multifocal intraocular lens(MIOL)implantation in the treatment of hard nuclear cataract.METHODS:A retrospective analysis was performed for 288 patients(288 eyes)with hard nuclear cataract who admitted to our hospital from January 2022 to December 2023, and they were divided into control group(144 eyes treated with phacoemulsification and regional refractive MIOL)and observation group(144 eyes treated with small-incision horizontal space nuclear splitting surgery and regional refractive MIOL)according to different treatment methods. The operation time, pre- and post-operative best corrected visual acuity, astigmatism, central corneal thickness, corneal endothelial density, tear film function, and complications were compared between the two groups.RESULTS:There was no difference in operation time between the two groups(P>0.05). There was no difference in the preoperative and 3 mo postoperative best corrected visual acuity(all P>0.05), and the best corrected visual acuity of the two groups at 3 mo postoperatively was improved compared with the preoperative level(all P<0.05). There were differences in central corneal thickness, corneal endothelial density and astigmatism between the two groups at 1 wk and 3 mo after surgery(all P<0.05). There were differences in breakup time(BUT)and ocular surface disease index(OSDI)scores between the two groups at 1 wk after surgery(all P<0.001), and the incidence of complications in the observation group(4.2%)was significantly lower than that in the control group(18.1%; P<0.001).CONCLUSION:Both surgical methods can effectively treat patients with hard nuclear cataracts, and small-incision horizontal space nuclear splitting surgery combined with regional refractive MIOL implantation has less corneal damage and fewer complications.

Chronic thromboembolic pulmonary hypertension (CTEPH), a severe long-term complication of acute pulmonary thromboembolism, is characterized by high mortality and disability rates.The Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension(2024 edition) represents the first comprehensive systematic evaluation of evidence-based medical evidence on CTEPH published domestically and internationally in recent years, formulating recommendations tailored to clinical practice in China to standardize the clinical diagnosis and management of CTEPH. This article provides an interpretative analysis focusing on early recognition of CTEPH, the diagnostic value of various imaging modalities, and the selection of therapeutic strategies, with the aim of providing clinical guidance and support.

Objective:To summarize the best evidence for intense pulsed light therapy in dry eye.Methods:Literature on intense pulsed light therapy for dry eye was electronically retrieved from databases and websites, including the National Guideline Clearinghouse, Guidelines International Network, British Medical Journal (BMJ) Best Practice, UpToDate, Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and China Biology Medicine disc. The search period was from database establishment to December 3, 2024. Two researchers independently conducted quality evaluation of the literature, and extracted and summarized the evidence.Results:A total of 22 articles were ultimately included, including four guidelines, seven expert consensus, and eleven systematic reviews. Twenty-seven piecesof evidence were summarized from six aspects of the mechanism of action, clinical indications, treatment protocols, operation and maintenance, therapeutic efficacy evaluation, adverse reactions, and precautions.Conclusions:The best evidence for intense pulsed light therapy in dry eye is evidence-based and scientific. Healthcare providers are advised to apply this evidence in conjunction with clinical context and patient preferences.

Objective:To investigate the role of a modified positioning device in improving image quality and diagnostic efficacy for thyroid cancer in contrast-enhanced neck CT imaging.Methods:This prospective cross-sectional study included 137 patients with pathologically confirmed thyroid lesions who underwent contrast-enhanced neck CT at Zhangzhou Affiliated Hospital of Fujian Medical University from January to April 2024. Patients scanned in January and February (modified positioning group, n=62) underwent scanning using the modified positioning device, whereas those scanned in March and April (traditional positioning group, n=75) underwent scanning with conventional positioning. The estimated volume CT dose index (CTDI vol) in the thyroid region was recorded. Subjective image quality for thyroid and neck regions was evaluated using a 5-point Likert scale. Diagnostic assessments for thyroid cancer, capsule invasion, and lymph node metastasis were independently conducted by one junior radiologist and one senior radiologist using a 5-point scoring system, with scores≥3 considered positive diagnoses. The differences of CTDI vol and image quality scores between the 2 groups were compared using Mann-Whitney U test. The diagnostic performance was evaluated by the receiver operating characteristic curve analysis. Results:The estimated CTDI vol values for the thyroid region were significantly lower in the modified positioning group compared to the traditional positioning group [11.20 (8.37, 13.56) vs. 12.46 (10.10, 19.43) mGy, Z=1.99, P=0.026]. Subjective image quality scores for thyroid and neck regions were significantly higher in the modified positioning group than in the traditional positioning group (all P<0.001). For thyroid cancer diagnosis by the senior radiologist, the modified positioning group had a significantly higher area under the curve (AUC) of 0.842 (95% CI 0.728-0.956) compared to the traditional positioning group (AUC=0.666,95% CI 0.554-0.777, Z=2.17, P=0.031). No significant differences were observed in diagnostic performance between the junior and senior radiologists for thyroid cancer, capsule invasion, and lymph node metastasis in other subgroup comparisons (all P>0.05). Conclusion:The modified positioning device using in contrast-enhanced neck CT imaging can improve image quality and diagnostic efficacy for thyroid cancer while reducing radiation exposure to the thyroid gland.

ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

BACKGROUND: Without timely and effective rehabilitation, hearing loss may profoundly affect human life quality. China has a large population of hearing-impaired individuals, which imposes a heavy health burden on society. Moreover, this population is projected to increase rapidly owing to China's aging society. METHODS: We used data from a population-representative epidemiological investigation of hearing loss and ear diseases in four Chinese provinces. We estimated the national prevalence using multiple linear regression of the age-group proportions and prevalence in 31 provinces with clustering analysis. We used years lived with disability (YLDs) to analyze the disease burden and forecasted the prevalence of hearing loss by 2060 in China. RESULTS: An estimated 115 million people had moderate-to-complete hearing loss in 2015 across the 31 provinces of China (8.4% of 1.37 billion people). Of these, 85.7% were older than age 50 years (99 million people) and 2.4% were younger than 20 years old (2.8 million people). Of all YLDs attributable to hearing loss, 68.9% were attributable to moderate-to-complete cases. By 2060, a projected 242 million people in China will have moderate-to-complete hearing loss, a 110.0% increase from 2015. CONCLUSIONS The hearing loss prevalence in China is high. Population aging and socioeconomic factors substantially affect the prevalence and severity of hearing loss and the disease burden. The prevalence and severity of hearing loss are unevenly distributed across different provinces. Future public health policies should take these trends and regional variations into account.
Humans ; China/epidemiology* ; Hearing Loss/epidemiology* ; Prevalence ; Middle Aged ; Male ; Female ; Adult ; Aged ; Adolescent ; Young Adult ; Child ; Child, Preschool ; Infant ; Aged, 80 and over ; Cost of Illness

Objective:To summarize the best evidence for intense pulsed light therapy in dry eye.Methods:Literature on intense pulsed light therapy for dry eye was electronically retrieved from databases and websites, including the National Guideline Clearinghouse, Guidelines International Network, British Medical Journal (BMJ) Best Practice, UpToDate, Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and China Biology Medicine disc. The search period was from database establishment to December 3, 2024. Two researchers independently conducted quality evaluation of the literature, and extracted and summarized the evidence.Results:A total of 22 articles were ultimately included, including four guidelines, seven expert consensus, and eleven systematic reviews. Twenty-seven piecesof evidence were summarized from six aspects of the mechanism of action, clinical indications, treatment protocols, operation and maintenance, therapeutic efficacy evaluation, adverse reactions, and precautions.Conclusions:The best evidence for intense pulsed light therapy in dry eye is evidence-based and scientific. Healthcare providers are advised to apply this evidence in conjunction with clinical context and patient preferences.

Objective:To investigate the role of a modified positioning device in improving image quality and diagnostic efficacy for thyroid cancer in contrast-enhanced neck CT imaging.Methods:This prospective cross-sectional study included 137 patients with pathologically confirmed thyroid lesions who underwent contrast-enhanced neck CT at Zhangzhou Affiliated Hospital of Fujian Medical University from January to April 2024. Patients scanned in January and February (modified positioning group, n=62) underwent scanning using the modified positioning device, whereas those scanned in March and April (traditional positioning group, n=75) underwent scanning with conventional positioning. The estimated volume CT dose index (CTDI vol) in the thyroid region was recorded. Subjective image quality for thyroid and neck regions was evaluated using a 5-point Likert scale. Diagnostic assessments for thyroid cancer, capsule invasion, and lymph node metastasis were independently conducted by one junior radiologist and one senior radiologist using a 5-point scoring system, with scores≥3 considered positive diagnoses. The differences of CTDI vol and image quality scores between the 2 groups were compared using Mann-Whitney U test. The diagnostic performance was evaluated by the receiver operating characteristic curve analysis. Results:The estimated CTDI vol values for the thyroid region were significantly lower in the modified positioning group compared to the traditional positioning group [11.20 (8.37, 13.56) vs. 12.46 (10.10, 19.43) mGy, Z=1.99, P=0.026]. Subjective image quality scores for thyroid and neck regions were significantly higher in the modified positioning group than in the traditional positioning group (all P<0.001). For thyroid cancer diagnosis by the senior radiologist, the modified positioning group had a significantly higher area under the curve (AUC) of 0.842 (95% CI 0.728-0.956) compared to the traditional positioning group (AUC=0.666,95% CI 0.554-0.777, Z=2.17, P=0.031). No significant differences were observed in diagnostic performance between the junior and senior radiologists for thyroid cancer, capsule invasion, and lymph node metastasis in other subgroup comparisons (all P>0.05). Conclusion:The modified positioning device using in contrast-enhanced neck CT imaging can improve image quality and diagnostic efficacy for thyroid cancer while reducing radiation exposure to the thyroid gland.

Rapid turnover of the intestinal epithelium is a critical strategy to balance the uptake of nutrients and defend against environmental insults, whereas inappropriate death promotes the spread of inflammation. PPARα is highly expressed in the small intestine and regulates the absorption of dietary lipids. However, as a key mediator of inflammation, the impact of intestinal PPARα signaling on cell death pathways is unknown. Here, we show that Pparα deficiency of intestinal epithelium up-regulates necroptosis signals, disrupts the gut vascular barrier, and promotes LPS translocation into the liver. Intestinal Pparα deficiency drives age-related hepatic steatosis and aggravates hepatic fibrosis induced by a high-fat plus high-sucrose diet (HFHS). PPARα levels correlate with TRIM38 and MLKL in the human ileum. Inhibition of PPARα up-regulates necroptosis signals in the intestinal organoids triggered by TNF-α and LPS stimuli via TRIM38/TRIF and CREB3L3/MLKL pathways. Butyric acid ameliorates hepatic steatosis induced by intestinal Pparα deficiency through the inhibition of necroptosis. Our data suggest that intestinal PPARα is essential for the maintenance of microenvironmental homeostasis and the spread of inflammation via the gut-liver axis.