Cataract is the world's leading cause of blindness, and surgery is the most effective treatment for cataract. With the development of femtosecond laser technology and ophthalmic surgical equipment, the application of femtosecond laser systems in cataract surgery is becoming increasingly widespread. It can be used in cataract surgery for corneal incisions, anterior capsulotomy, lens fragmentation, arcuate incisions and other key operations. Compared to traditional surgery, femtosecond laser assisted cataract surgery(FLACS)offers significant advantages in precision, safety and postoperative visual outcomes. Its clinical benefits have garnered growing recognition among ophthalmologists. However, the key technologies and high-precision equipment for FLACS remain predominantly controlled by Western countries. In China, the research in this field began later. This article reviews the technological advancements in FLACS, with a focus on femtosecond laser technology, optical coherence tomography(OCT), artificial intelligence, and clinical application progress. The objective is to provide theoretical foundations and practical insights for the development of ophthalmic medical technology in China.

Gut microbial communities are likely remodeled in tandem with accumulated physiological decline during aging, yet there is limited understanding of gut microbiome variation in advanced age. Here, we performed a metagenomics-based enterotype analysis in a geographically homogeneous cohort of 367 enrolled Chinese individuals between the ages of 60 and 94 years, with the goal of characterizing the gut microbiome of elderly individuals and identifying factors linked to enterotype variations. In addition to two adult-like enterotypes dominated by Bacteroides (ET-Bacteroides) and Prevotella (ET-Prevotella), we identified a novel enterotype dominated by Escherichia (ET-Escherichia), whose prevalence increased in advanced age. Our data demonstrated that age explained more of the variance in the gut microbiome than previously identified factors such as type 2 diabetes mellitus (T2DM) or diet. We characterized the distinct taxonomic and functional profiles of ET-Escherichia, and found the strongest cohesion and highest robustness of the microbial co-occurrence network in this enterotype, as well as the lowest species diversity. In addition, we carried out a series of correlation analyses and co-abundance network analyses, which showed that several factors were likely linked to the overabundance of Escherichia members, including advanced age, vegetable intake, and fruit intake. Overall, our data revealed an enterotype variation characterized by Escherichia enrichment in the elderly population. Considering the different age distribution of each enterotype, these findings provide new insights into the changes that occur in the gut microbiome with age and highlight the importance of microbiome-based stratification of elderly individuals.
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Bacteroides ; China ; Diabetes Mellitus, Type 2/microbiology* ; Escherichia coli/classification* ; Gastrointestinal Microbiome/genetics* ; Metagenomics ; East Asian People

Cognitive dysfunction often occurs in Alzheimer's disease, Parkinson's disease, cerebrovascular disease, or other neurodegenerative diseases, and can significantly impact the life quality of patients and create serious social, psychological, and economic burdens for individuals and their families. Numerous studies have confirmed that exercise can slow the decline in cognitive function through multiple pathways, in which fibronectin type III domain-containing protein 5 (FNDC5) plays an important role. However, the current research on the modulation of FNDC5 by exercise and its ability to improve hippocampal cognitive function lacks a systematic and comprehensive understanding. Therefore, this review focuses on the latest research progress regarding the role of exercise-induced FNDC5 in cognitive function, systematically reviews the positive effects of FNDC5 on cognitive function impairment caused by various factors, and clarifies the specific mechanisms by which exercise-induced FNDC5 improves cognitive function by inhibiting neuroinflammation and improving hippocampal neurogenesis and hippocampal synaptic plasticity. Based on the existing literature, we also identify the areas that require further research in this field. Overall, this review provides a theoretical basis for exercise-based prevention and improvement of cognitive function impairment.
Humans ; Cognition/physiology* ; Fibronectins/physiology* ; Exercise/physiology* ; Hippocampus/physiology* ; Cognitive Dysfunction/prevention & control* ; Neuronal Plasticity ; Animals ; Neurogenesis

Objective To analyze the risk of return to sport in athletes using their gait data following anterior cruciate ligament re-construction(ACLR). Methods From May to June,2023,39 athletes after ACLR were recruited in Wuhan Sports University.Their data on sta-ble gait and tandem gait were recorded using a three-dimensional motion capture system,surface electromyogra-phy and a three-dimensional ergometer table.Additionally,return-to-sport scores were calculated using the K-STARTS test.The relationship between each gait indicator and the total score of the K-STARTS test was ana-lyzed with Pearson correlation analysis.Furthermore,the key indicators related to the risk of return to sport were analyzed using linear regression. Results In the stable gait test,the step time was negatively correlated with the total score of K-STARTS(r=-0.479,P=0.002),and the peak amplitude symmetry index of rectus femoris(r=0.448,P=0.004)and vastus lateralis(r=0.595,P=0.001)were positively correlated with the total score of K-STARTS.In the tandem gait test,the lateral displacement distance of the center of gravity was negatively correlated with the total score of K-STARTS(r=-0.341,P=0.034),and the time symmetry index of peak amplitude of vastus lateralis was positively correlated with the total score of K-STARTS(r=0.320,P=0.047).Regression analysis showed that the interpretation of the model based on stable gait(F=15.818,P=0.001,R2=0.650)was better than that based on tandem gait(F=7.692,P=0.001,R2=0.397). Conclusion In stable gait,gait rhythm variability and symmetry are correlated with return to sport risk.In tandem gait,gait balance and symmetry indexes are correlated with return-to-sport risk.Compared with tandem gait,the inter-pretation of return-to-sport risk assessment model based on stable gait information is better,and may be more suitable as a simple return-to-sport risk test method.

Objective To compare the effects of six composite fixatives on paraffin sections of golden hamster retinal tissue, and to optimize the fixation methods for retinal tissue paraffin sections of golden hamsters. Methods Eighteen male SPF grade golden hamsters were taken and randomly divided into six groups of three animals each. After each animal was anesthetized by intraperitoneal injection of sodium pentobarbital, cardiac perfusion was performed using 4% paraformaldehyde, Bouin's, Carnoy, Davidson's, Zenker, and Helly fixatives, respectively. The eye tissues of each animal were taken out to make eye cups and put into the corresponding compound fixative solution for fixation, and then taken out for paraffin embedding after 48 h. The embedded blocks were sliced using microtome, and then stained with hematoxylin and eosin (HE). The morphological characteristics of retinal tissue cells were observed under a light microscope and scored in a double-blind method to statistically analyze the fixation effect and staining quality of various composite fixative solutions. ResultsRetinal sections fixed with Davidson's fixative exhibited intact morphology without breaks, clear structural layers, well-morphosed nuclei, and tight adhesion between the retina, sclera, and uvea. In contrast, sections fixed with 4% paraformaldehyde, Bouin's, and Carnoy fixatives showed varying degrees of retinal breaks and detachment from the sclera. Sections fixed with Zenker and Helly fixatives demonstrated the poorest quality, characterized by pronounced detachment, large fissures, unclear cell layers, and pale staining. Statistical analysis using SPSS 27.0 software revealed significant differences in mean scores among the six fixatives (P<0.001). The fixation quality ranking was as follows: Davidson's fixative > 4% paraformaldehyde > Bouin's fixative > Carnoy fixative > Helly fixative > Zenker fixative. Zenker and Helly fixatives showed significantly lower scores than the other fixatives (P<0.001), while no significant differences were observed among the remaining fixatives (P>0.05). Conclusion Davidson's fixative provides the best fixation and staining results, followed by 4% paraformaldehyde and Bouin's fixative. Carnoy fixative exhibits suboptimal performance, while Zenker and Helly fixatives result in the poorest outcomes. Therefore, Davidson's fixative is recommended as the optimal fixative for golden hamster retinal tissue, with 4% paraformaldehyde, Bouin's and Carnoy fixatives as alternative options.

Objective:To compare the prognostic values of different classification by using transpulmonary pressure gradient (TPG), diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) in patients with pulmonary hypertension due to left heart disease (PH-LHD), and investigated hemodynamic and clinical factors associated with mortality in patients with PH-LHD.Methods:This was a single-center prospective cohort study. In-hospital patients diagnosed with PH-LHD via right heart catheterization at the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, from September 2013 to December 2019 were enrolled. Patients were divided according to TPG (cutoff value 12 mmHg; 1 mmHg=0.133 kPa), DPG (cutoff value 7 mmHg), PVR (cutoff value 3 Wood Units), and the combination of TPG and PVR. Baseline characteristic was recorded. All patients were followed up until the occurrence of endpoint event, defined as all-cause death that occurred during the follow-up period, or until April 18, 2022. Receiver operating characteristic curves were used to compare the predictive value of 3 classification methods for all-cause death in PH-LHD patients. The optimal cutoff values were calculated using Jorden index. Survival analysis was performed using Kaplan-Meier analysis, and log-rank test was used to compare the predictive efficacy of classification methods based on optimal cutoff values or guidance-recommended thresholds for the survival of PH-LHD patients. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality.Results:A total of 243 patients were enrolled, aged (54.9±12.7) years old, including 169 (69.5%) males. During a median follow-up of 57 months, there were 101 (41.6%) deaths occurred. Grouping results were as follows: (1) TPG: TPG≤12 mmHg group 115 patients, TPG>12 mmHg group 128 patients; (2) DPG: DPG<7 mmHg group 193 patients, DPG≥7 mmHg group 50 patients; (3) PVR: PVR≤3 Wood Units group 108 patients, PVR>3 Wood Units group 135 patients; (4) TPG and PVR: TPG≤12 mmHg and PVR≤3 Wood Units group 89 patients, TPG>12 mmHg and PVR>3 Wood Units group 109 patients. PVR ( AUC=0. 698,95% CI:0.631-0.766) had better predictive value for all-cause mortality than TPG ( AUC=0.596, 95% CI: 0.523-0.669) and DPG ( AUC=0.526, 95% CI: 0.452-0.601) (all P<0.05). The optimal cutoff values for TPG, DPG, and PVR were13.9 mmHg, 2.8 mmHg, and 3.8 Wood Units, respectively. Kaplan-Meier analysis based on the optimal cutoff values or guidance-recommended thresholds showed that PVR and TPG were the predictors of survival ( P<0.05), while DPG did not showed significance ( P>0.05). Multivariate Cox regression analysis showed that age, PVR and log 2N-terminal pro-B-type natriuretic peptide were independent risk factors for all-cause mortality in PH-LHD patients (all P<0.05). Conclusion:Classification according to PVR was most valuable in predicting all-cause death in PH-LHD patients, while TPG showed moderate predictive ability and DPG had no predictive value.

Conventional 1.5T and 3.0T cardiac MRI(CMRI)had been widely used.The ultrahigh field MR behaved better in image resolution and signal-to-noise ratio.The domestic 5.0T whole-body ultrahigh field MRI had better balance between the field strength and quality in CMRI,which was expected to improve imaging quality and efficiency.The status challenges and future of 5.0T CMRI were reviewed in this paper.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-positive bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-positive bacteria from blood cultures in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:A total of 3 163 strains of Gram-positive pathogens were collected from 51 member units，and the top five bacteria were Staphylococcus aureus（ n=1 147，36.3%），coagulase-negative Staphylococci（ n=928，29.3%）， Enterococcus faecalis（ n=369，11.7%）， Enterococcus faecium（ n=296，9.4%）and alpha-hemolyticus Streptococci（ n=192，6.1%）. The detection rates of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）were 26.4%（303/1 147）and 66.7%（619/928），respectively. No glycopeptide and daptomycin-resistant Staphylococci were detected. The sensitivity rates of Staphylococcus aureus to cefpirome，rifampin，compound sulfamethoxazole，linezolid，minocycline and tigecycline were all >95.0%. Enterococcus faecium was more prevalent than Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were both 0.5%（2/369），and no vancomycin-resistant Enterococcus faecium was detected. The detection rate of MRSA in southern China was significantly lower than that in other regions（ χ2=14.578， P=0.002），while the detection rate of MRCNS in northern China was significantly higher than that in other regions（ χ2=15.195， P=0.002）. The detection rates of MRSA and MRCNS in provincial hospitals were higher than those in municipal hospitals（ χ2=13.519 and 12.136， P<0.001）. The detection rates of MRSA and MRCNS in economically more advanced regions（per capita GDP≥92 059 Yuan in 2022）were higher than those in economically less advanced regions（per capita GDP<92 059 Yuan）（ χ2=9.969 and 7.606， P=0.002和0.006）. Conclusions:Among the Gram-positive pathogens causing bloodstream infections in China， Staphylococci is the most common while the MRSA incidence decreases continuously with time；the detection rate of Enterococcus faecium exceeds that of Enterococcus faecalis. The overall prevalence of vancomycin-resistant Enterococci is still at a low level. The composition ratio of Gram-positive pathogens and resistant profiles varies slightly across regions of China，with the prevalence of MRSA and MRCNS being more pronounced in provincial hospitals and areas with a per capita GDP≥92 059 yuan.

Objective:To investigate the features and influencing factors of language in children with various types of speech disorders.Methods:A case-control study was carried out, 262 children with speech disorder had been diagnosed at the language-speech clinic of the Center of Children′s Healthcare, Children′s Hospital, Capital Institute of Pediatrics from January 2021 to November 2023, the children with speech sound disorder as the speech sound disorder group, the children with developmental stuttering as the stuttering group. There were 100 typically-developed children who underwent physical checkups at the Center of Healthcare during the same period as the healthy group. All children experienced a standardized evaluation of language with diagnostic receptive and expressive assessment of mandarin‐comprehensive(DREAM-C) and questionnaire, One-way ANOVA and LSD test were conducted to compare the differences in overall language, receptive language, expressive language, semantics, and syntax scores among 3 groups of children. According to the results of DREAM-C, the children with speech disorder were divided into language normal group and language delay group. Chi‐square test and multivariate Logistic regression were implemented to analyze the association between the linguistic development of children with speech disorder and potential influential factors.Results:There were 145 children in the speech sound disorder group, including 110 males and 35 females respectively, with an age of (5.9±1.0) years; 117 children in the stuttering group, including 91 males and 26 females, with an age of (5.8±1.0) years; 100 children in the healthy group, including 75 males and 25 females, with an age of (5.7±1.2) years. The variations in overall language, expressive language, and syntax scores among 3 groups of children were statistically significant (92±18 vs.96±11 vs. 98±11, 81±18 vs. 84±14 vs. 88±13, 87±16 vs. 89±11 vs. 91±10, F=5.46, 4.69, 3.68, all P<0.05). Pairwise comparison revealed that the speech sound disorder group had lower scores in overall language, expressive language, and syntactic compared to the healthy group, and the differences were statistically significant (all P<0.01) and the overall language score was lower than that of children with stuttering ( P<0.05). In terms of overall language and expressive language, there was a statistically significant difference in the incidence of language delay among the three groups of children (15.9% (23/145) vs. 20.5% (24/117) vs. 7.0% (7/100), 46.2% (67/145) vs. 39.3% (46/117) vs. 26.0% (26/100); χ2=7.93, 10.28; both P<0.05). In terms of overall language, the stuttering group took up the highest proportion. In terms of expressive language, the speech sound disorder group accounted for the highest amount. The incidence of language delay in children with speech disorder was 44.3% (116/262). Non-parent-child reading, daily screen time ≥1 hour and screen exposure before 1.5 years of age are risk factors for the development of language in children with speech disorder ( OR=1.87, 2.18, 2.01; 95% CI 1.07-3.27, 1.23-3.86, 1.17-3.45; all P<0.01). Negative family history are protective factors for the progress of language ability ( OR=0.37, 95% CI 0.17-0.81, P<0.05). Conclusions:Children with speech disorder tend to have easy access to language delay, especially in expressive language and syntax. The occurrence of language delay in children with speech disorder is tightly connected with factors such as the family medical history, parent-child reading, screen time, etc. Attention should be paid to the development of language in children who suffer from speech disorder.

Abstract: Objective　To explore the epidemiological and clinical characteristics of non-tuberculous mycobacterial(NTM) pulmonary disease in Hainan in recent years, and to provide data support for the prevention and treatment of NTM pulmonary disease. Methods　Medical records of patients diagnosed with NTM pulmonary disease who treated at the Second Affiliated Hospital of Hainan Medical University (Hainan Provincial Tuberculosis Hospital) from January 2018 to December 2022 were collected. The demographics, regional distribution, temporal distribution, distribution of mycobacterial species, clinical symptoms, and radiological imaging changes of these patients were analyzed. Results　A total of 225 confirmed cases of NMT pulmonary disease were collected in this study, with 133(59.1%) female patients outnumbering 92(40.9%) male patients. The disease predominantly affected people over 50 years old, with 192 cases (85.3%), and the major onset age range was 61-<81 years old, with a median age of 63 and an average age of 62. Farmers comprised the majority of the patients, with 112 cases (49.8%). More patients were from the western region (90 cases, 40.0%) than from the central region (76 cases, 33.8%), followed by the eastern region (59 cases, 26.2%). A total of 10 strains were detected from 225 samples, with the most common strains being Mycobacterium intracellulare (92 cases, 40.9%), Mycobacterium chelonae/abscessus(80 cases, 35.6%), and Mycobacterium avium (15 cases, 6.7%), followed by Mycobacterium kansasii (5 cases, 2.2%), Mycobacterium fortuitum (4 cases, 1.8%), and Mycobacterium parascrofulaceum (3 cases, 1.3%). There were 10 cases (4.5%) of mixed infections, including Mycobacterium avium and Mycobacterium intracellulare (8 cases, 3.6%), Mycobacterium intracellulare and Mycobacterium chelonae/abscessus (1 case, 0.4%), and Mycobacterium fortuitum and Mycobacterium chelonae/abscessus (1 case, 0.4%). The primary clinical manifestations of NTM pulmonary disease included cough and sputum (219 cases, 97.3%), hemoptysis (92 cases, 40.9%), fever (61 cases, 27.1%), dyspnea (57 cases, 25.3%), night sweats (52 cases, 23.1%), weight loss (50 cases, 22.2%), and thoracodynia (35 cases, 15.6%). There was no significant difference in symptoms between male and female patients. Pleural thickening (188 cases, 83.6%) and bronchiectasis (151 cases, 67.1%) were the most common imaging changes in NTM pulmonary disease, followed by cavities (93 cases, 41.3%), emphysema (41 cases, 18.2%), and lung damage (28 cases, 12.4%). Male patients were more likely to have lung damage and emphysema, while female patients were more likely to have bronchiectasis. Conclusions　The distribution of NTM species is diverse in Hainan area, with Mycobacterium intracellulare, Mycobacterium chelonae/abscessus, and Mycobacterium avium are dominant species. NTM pulmonary disease and pulmonary tuberculosis have similar clinical features, which requires attention for differentiation in clinical practice.