AIM:To investigate the dynamic changes in ocular surface function after eyelid malignant tumor resection combined with Hughes flap reconstruction.

METHODS:A prospective self-controlled study was conducted. Patients who underwent eyelid malignant tumor resection combined with Hughes tarsoconjunctival flap reconstruction(all tumors occured in the lower eyelid)at Shanxi Eye Hospital from January 2021 to December 2023 were enrolled. The contralateral healthy eye served as control. Ocular surface examinations were performed preoperatively and at 3, 6, 9, and 12 mo postoperatively, including ocular surface disease index(OSDI), tear meniscus height(TMH), non-invasive average tear film break-up time(NiaBUT), tear film lipid layer grading, upper and lower eyelid meibomian gland dropout grading, corneal fluorescein staining, and eye redness index.

RESULTS:A total of 36 patients were enrolled. Two patients were lost to follow-up because they did not complete the scheduled follow-up period, leaving 34 patients with complete data for analysis. The cohort comprised 10 men(29%)and 24 women(71%), with a mean age of 70.08±10.92 y(range 33-81 y). Histopathological diagnoses included basal cell carcinoma(BCC)in 22 eyes(65%), sebaceous gland carcinoma(SGC)in 10 eyes(29%), and squamous cell carcinoma(SCC)in 2 eyes(6%). Tumor size ranged from 4 to 30 mm(mean 12.64±0.31 mm). According to the AJCC staging system, 14 eyes(41%), 18 eyes(53%), and 2 eyes(6%)were classified as T1b, T2b, and T3b, respectively. Preoperatively, OSDI scores were higher in surgical eyes than in contralateral healthy eyes(28.74±13.72 vs 17.47±3.02, P<0.05). OSDI scores in surgical eyes further increased at 6, 9, and 12 mo postoperatively, peaking at 9 mo(all P<0.05), whereas no significant postoperative changes were observed in contralateral healthy eyes. Compared with contralateral healthy eyes, TMH in surgical eyes increased significantly at 3 mo postoperatively and remained elevated thereafter despite a slight decline(all P<0.05). NiaBUT in surgical eyes was shorter than the preoperative value from 3 mo postoperatively onward and was lower than that in contralateral healthy eyes(all P<0.05). Eye redness index in surgical eyes were consistently higher than those in contralateral healthy eyes(all P<0.001). Tear film lipid layer grade and meibomian gland dropout grades in both the upper and lower eyelids were significantly worsened postoperatively compared with baseline(all P<0.001). Corneal fluorescein staining grades were higher in surgical eyes than in contralateral healthy eyes preoperatively(P<0.001)and were higher at 3, 6, 9, and 12 mo postoperatively than at baseline(all P<0.001).

CONCLUSION: After lower eyelid malignant tumor resection combined with Hughes flap reconstruction, evaporative dry eye is the predominant phenotype. Meibomian gland dropout in both upper and lower eyelids appears irreversible within 12 mo postoperatively, and corneal epithelial damage and ocular surface inflammation persist over time.

Gene therapy, harnessing the power of CRISPR-Cas9 and/or DNAzyme systems, stands as a pivotal approach in cancer therapy, enabling the meticulous manipulation of genes pivotal to tumorigenesis and immunity. However, the pursuit of precise gene therapy encounters formidable hurdles. Herein, a near-infrared upconversion theranostic nanomachine is devised and tailors for CRISPR-Cas9/DNAzyme systems mediate precise gene therapy. An ingenious logic DNAzyme system consists of Chain 1 (C1)/Chain 2 (C2) and endogenous lncRNA is designed. We employ manganese modified upconversion nanoparticles for carrying ultraviolet-responsive C1-PC linker-C2 (C₂P) chain and Cas9 ribonucleoprotein (RNP), with outermost coats with hyaluronic acid. Upon reaching tumor microenvironment (TME), the released Mn²⁺ ions orchestrate a trifecta: facilitating endosomal escape, activating cGAS-STING signaling, and enabling T1-magnetic resonance imaging. Under near-infrared irradiation, Cas9 RNP/C₂P complex dissociates, releasing Cas9 RNP into the nucleus to perform gene editing of Ptpn2, while C1/C2 chains self-assemble with endogenous lncRNA to form a functional DNAzyme system, targeting PD-L1 mRNA for gene silencing. This strategy remodels the TME by activating cGAS-STING signaling and dual immune checkpoints blockade, thus realizing tumor elimination. Our theranostic nanomachine armed with the CRISPR-Cas9/DNAzyme logic systems, represents a resourceful and promising strategy for advancing cancer systemic immunotherapy and precise gene therapy.

PURPOSE: Traumatic brain injury (TBI) is a significant public health issue that impacts individuals all over the world and is one of the main causes of mortality and morbidity. Decompressive craniectomy is the usual course of treatment. Basal cisternostomy has been shown to be highly effective as an alternative procedure to decompressive craniectomy. METHODS: We conducted a retrospective cohort of patients who received surgery for severe TBI between January 2019 and March 2023. Inclusion criterias were patients between the ages of 18 and 70 years who met the diagnostic criteria for severe TBI at first presentation and who underwent surgical intervention. The exclusion criteria were patients who have severe multiple injuries at the time of admission; preoperative intracranial pressure > 60 mmHg; cognitive impairment before the onset of the disease; hematologic disorders; or impaired functioning of the heart, liver, kidneys, or other visceral organs. Depending on the surgical approach, the patients were categorized into decompressive craniectomy group as well as basal cisternostomy group. General data and postoperative indicators, including Glasgow coma scale, intracranial pressure, etc., were recorded for both groups of patients. Among them, the Glasgow outcome scale extended assessment at 6 months served as the primary outcome. After that, the data were statistically analyzed using SPSS software. RESULTS: The trial enrolled 41 patients (32 men and 9 women) who met the inclusion criteria. Among them, 25 patients received decompressive decompressive craniectomy, and 16 patients received basal cisternostomy. Three days postoperative intracranial pressure levels were 10.07 ± 2.94 mmHg and 17.15 ± 14.65 mmHg (p = 0.013), respectively. The 6 months following discharge Glasgow outcome scale extended of patients was 4.73 ± 2.28 and 3.14 ± 2.15 (p = 0.027), respectively. CONCLUSION Our study reveals that basal cisternostomy in patients with surgically treated severe TBI has demonstrated significant efficacy in reducing intracranial pressure as well as patient prognosis follow-up and avoids removal of the bone flap. The efficacy of cisternostomy has to be studied in larger, multi-clinical center randomized trials.
Humans ; Brain Injuries, Traumatic/surgery* ; Retrospective Studies ; Male ; Female ; Adult ; Middle Aged ; Decompressive Craniectomy/methods* ; Aged ; Young Adult ; Adolescent ; Glasgow Coma Scale ; Treatment Outcome

Skeletal class Ⅱ malocclusion is characterized by maxillary protrusion,mandibular retrognathia,or a combination of both,and often accompanied by vertical dimensional discrepancies;treatment is complex,and combined orthodontic-orthognathic surgery is needed for the adult patients.Clear aligner therapy has gradually been applied in complex orthodontic cases.However,limited cases have been reported domestically and internationally regarding the application of clear aligner therapy combined with orthognathic surgery.This article presented a case of a patient with skeletal class Ⅱ high-angle malocclusion treated with the combined therapy and analyzed the clinical efficacy of the treatment appraoch to provide reference for the clinical practice.Extraction of impacted wisdom teeth 18,28,38,and 48,as well as orthodontic teeth 15,25,34,and 44,was performed in stages before orthodontic treatment.Clear aligner therapy was used for preoperative orthodontics.In sagittal plane,a super-complete class Ⅱ canine and molar relationship and a 13-14 mm overjet of the anterior teeth were established.The maxillary and mandibular arch morphology was matched horizontally.The orthognathic surgery included maxillary LeFort Ⅰ osteotomy,bilateral sagittal split ramus osteotomy(BSSRO)and chinplasty.Fine occlusal adjustment was conducted after operation.After treatment,the skeletal relationship between upper and lower jaw was corrected to normal;subspinale-nasion-supramental angle(ANB)was improved from 12.3° to 4.7°;the patient established the class Ⅰ canine and molar relationship,with normal overjet and overbite;root parallelism was good and there was no obvious root resorption;the facial soft tissue profile was significantly improved,and nasion-subnasale-pogonion angle(N-Sn-Pg)was improved from 143.9° to 162.8°.The curative effect was stable 1 year after operation.Clear aligner therapy can efficiently complete combined orthodontic and orthodontic surgery in the complex cases.Compared with the fixed appliance,it is more beneficial to the patients'need for beauty and the maintenance of periodontal health.

Objective:To propose a thyroid nodule ultrasound image segmentation method based on a feature-adaptive extraction and gated fusion mechanisms net (FAGF-Net).Methods:The FAGF-Net was constructed by designing a feature coupling encoder (FC-Encoder), which integrated a convolutional neural network and a Transformer to extract both local and global features. The perception of multi-scale geometric characteristics of nodules was enhanced by developing a multi-scale feature space coupling module (MFSC-Module), and a context-gated feature attention module (CGFA-Module) was introduced to filter redundant information and suppress noise interference. A retrospective analysis was conducted on 3 493 physician-annotated two-dimensional thyroid nodule ultrasound images obtained from the publicly available TN3K medical imaging dataset. The dataset was divided into training and validation sets at a ratio of 8∶2, resulting in 2 794 training images and 699 validation images. FAGF-Net was compared with several mainstream semantic segmentation models, including UNet, Deeplabv3, HRNet, PSPNet, and SegFormer using UNet as the baseline model. Additionally, module ablation experiments were performed to evaluate the effectiveness of each core module within the FAGF-Net. Visual comparisons were also conducted between the original ultrasound images, the annotated nodule regions, and the segmentation results produced by the different models.Results:The accuracy, intersection over union and Dice coefficient of the FAGF-Net method were 95.59%, 83.53% and 90.60%, respectively. These values were 3.77%, 2.29% and 3.55% higher than those of the UNet method (91.82%, 81.24% and 87.05%). Additionally, the FAGF-Net method achieved a frame rate of 19.8, meeting the requirements for image segmentation in medical environment scenarios. The module ablation experiments showed that compared with the UNet, the accuracy (92.85%), intersection over union (81.76%) and Dice coefficient (88.45%) of the FC-Encoder model were increased by 1.03%, 0.52% and 1.40%, respectively. The accuracy (93.13%), intersection over union (81.91%) and Dice coefficient (88.76%) of the CGFA-Module model were introduced separately, which were 1.31%, 0.67% and 1.71% higher than those of UNet, respectively. Compared with the FC-Encoder model alone, the accuracy (94.61%), intersection over union (82.45%) and Dice coefficient (89.54%) of the MFSC-Module increased by 1.76%, 0.69% and 1.09%, respectively when FC-Encoder was used as the feature double branch extraction encoder. Compared with the FC-Encoder model alone, the accuracy (94.39%), intersection over union (82.33%) and Dice coefficient (89.46%) of the CGFA-Module were increased by 1.54%, 0.57% and 1.01%, respectively, when FC-Encoder was used as the feature double branch extraction encoder. Visualization results showed that the FAGF-Net method produced smoother and more complete in boundary fitting and was more accurate at identifying small and low-contrast lesions.Conclusions:A thyroid nodule ultrasound image segmentation method based on FAGF-Net was proposed, which effectively improves the segmentation accuracy of thyroid nodule ultrasound image segmentation.

Objective:To establish an HPLC method to simultaneously determine the contents of 7 components, including Cardol triene, Cardol diene, (8'Z,11'Z,14'Z)-5-(Heptadeca-8',11',14'-trienyl)benzene-1,3-diol, Alkylresorcinol B, 5-(8'Z,11'Z-heptadecadienyl)-1,3-benzenediol, Adipostatin A, and 5-(11'Z-heptadecenyl)-resorcinol in Embelia laeta (L.) Mez. Methods:Chromatographic column was Arcus EP-C18(4.6 mm×250 mm, 5 μm); mobile phase was methanol-water (90∶10); column temperature was 25 ℃; flow rate was 1 ml/min; detection wavelength was 220 nm; the injection volume was 10 μl.Results:The 7 compounds in Embelia laeta (L.) Mez showed good linear relationships, which sample recovery rate ranges from 97.69%- 100.62%. The average contents of the 7 components from 9 origins were 3.099 9, 6.246 3, 9.942 8, 4.093 7, 2.180 3, 0.960 2, 1.855 9 mg/g. Conclusion:The established HPLC method for simultaneous determination of the contents of 7 components in Embelia laeta (L.) Mez is feasible, which can provide references for further development and utilization of Embelia laeta (L.) Mez.

Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

Human Respiratory Stem Cells (RSCs) play a crucial role in the maintenance, repair and regeneration of the respiratory system. As a novel therapeutic method, stem cell therapy is a popular research direction in the medical field. And with the in-depth research on the mechanism of pneumonia caused by respiratory infections in recent years, the use of RSCs to explore pneumonia caused by respiratory infections and its therapeutic strategies has become a hot topic. In this paper, we firstly outlined the types of RSCs, summarized the mechanism of pneumonia caused by respiratory tract infections, discussed the advantages of RSCs application and the progress of culture differentiation, and elaborated the therapeutic exploration of RSCs in pneumonia caused by respiratory tract infections.

Objective:To determine the epidemiological characteristics of human bocavirus (HBoV) in children with acute respiratory infections (ARI) in Bengbu City, Anhui Province, in 2024.Methods:Nasopharyngeal swab samples were collected from 269 children with ARI in Bengbu City, Anhui Province, in 2024. Seventeen respiratory pathogens were screened using quantitative fluorescence PCR. For HBoV-positive samples, the VP1/VP2 structural gene fragments of HBoV were amplified and sequenced for genetic evolutionary analysis.Results:Among the 269 nasopharyngeal swab samples from children with ARI, the overall detection rate of respiratory pathogens was 48.33% (103/269). The top three pathogens with the highest detection rates were: Influenza A virus (FluA): 10.04% (27/269), Respiratory syncytial virus (RSV): 8.18% (22/269), Human bocavirus (HBoV): 7.43% (20/269). The age distribution of HBoV-infected children showed that the detection rate was highest in the 0-2 years age group (50%, 10/20), followed by the 3-5 years age group (25%, 5/20) and the over 6 years age group (25%, 5/20). However, there was no statistically significant difference in viral detection rates among the age groups. Genetic evolutionary analysis based on VP1/VP2 revealed that all 13 HBoV strains were of the HBoV-1 genotype.Conclusions:HBoV is one of the major pathogens causing ARI in children in Bengbu City, Anhui Province, in 2024, with HBoV-1 being the predominant genotype. Additionally, infants aged 0-2 years are the most susceptible population to HBoV infection.