Apparent accommodation originates from the residual accommodation function after the absence of classic lens accommodation, serving as a critical theoretical framework in the study of visual function after refractive cataract surgery. Different from Von Helmholtz's theory, which focuses on lens deformation, it evaluates the overall accommodation capability of the eye excluding the lens, with its mechanisms remaining debated. Apparent accommodation refers to the character that pseudophakic eyes retain a certain degree of refractive accommodation after natural lens removal or intraocular lens(IOL)implantation, despite the loss of physiological accommodation. This paper systematically reviews the historical development of apparent accommodation and the advances in assessment techniques, which have gradually contributed to the re-evaluation and expansion of classical theories of physiological accommodation. Recent studies attempt to decipher the synergistic effects between pupil, corneal, and central cognitive processing by integrating optical parameter measurements with neural adaptation. This reflects a shift in the field from a singular anatomical explanation to a more interdisciplinary and multi-dimensional model.

Background Recent advances in understanding the toxic effects of inorganic arsenic have revealed that arsenic exposure impacts multiple endocrine organs, thereby altering their functions. However, the mechanisms underlying arsenic-induced thyroid injury remain unclear. Objective To investigate the mechanisms by which sodium arsenite (NaAsO₂) affects the proliferation and apoptosis of normal thyroid cells (Nthy-ori3-1) through the estrogen receptor (ER)-phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. Methods Nthy-ori3-1 cells were cultured in vitro and divided into the following groups: a control group (complete medium without drugs, 0 μmol·L⁻¹), and NaAsO₂-treated groups at 1, 2, and 4 μmol·L⁻¹. Additionally, 1 μmol·L⁻¹ of the ER inhibitor ICI182780 was used to intervene in the NaAsO₂ exposure groups, resulting in the following combinations: 1 μmol·L⁻¹ NaAsO₂ + ICI182780, 2 μmol·L⁻¹ NaAsO₂ + ICI182780, and 4 μmol·L⁻¹ NaAsO₂ + ICI182780. The median lethal concentration of NaAsO₂ was determined using cell viability assay. Cell viability was assessed at 24, 36, and 48 h using Cell Counting Kit-8 (CCK-8) assay. Colony formation ability was evaluated via plate cloning assay. Apoptosis was detected using Hoechst 33342 staining. Protein and mRNA expression levels of ERα, ERβ, c-MYC, Bax, Bcl-2, PI3K, p-PI3K, AKT, and p-AKT were measured using Western blot (WB) and real-time quantitative PCR (qRT-PCR), respectively. Results The median lethal concentration of NaAsO₂ was determined to be 4.034 μmol·L⁻¹. CCK-8 assay at 24, 36, and 48 h revealed that, compared with the control group, the 1, 2, and 4 μmol·L⁻¹ NaAsO₂ groups significantly inhibited Nthy-ori3-1 cell proliferation (P < 0.001). The plate cloning assays demonstrated a concentration-dependent reduction in colony formation ability (P < 0.001). Following the ICI182780 intervention, the cell viability and colony formation ability in the 1, 2, and 4 μmol·L⁻¹ NaAsO₂ groups were significantly restored compared with the corresponding NaAsO₂-only groups (P < 0.001, P < 0.01). The Hoechst 33342 staining indicated that compared with the control group, the nuclear staining intensity and apoptosis levels in the 1, 2, and 4 μmol·L⁻¹ NaAsO₂ groups increased in a concentration-dependent manner (P < 0.001). However, the ICI182780 intervention reduced the apoptosis levels in the NaAsO₂-treated groups compared with their NaAsO₂-only counterparts (P < 0.001). The WB analysis showed that, compared with the control group, the protein expression of ERα, ERβ, c-MYC, Bcl-2, p-PI3K, and p-AKT in the 1, 2, and 4 μmol·L⁻¹ NaAsO₂ groups decreased manner (P < 0.001, P < 0.01), while the Bax expression increased in a concentration-dependent (P < 0.001); the PI3K and AKT protein levels showed no significant differences (P > 0.05). In the ICI182780-treated NaAsO₂ groups, the ERα, ERβ, c-MYC, Bcl-2, p-PI3K, and p-AKT protein expression increased (P < 0.001, P < 0.01), the Bax expression decreased (P < 0.001), and the PI3K and AKT levels remained unchanged (P > 0.05) compared with the corresponding NaAsO₂-only groups. The mRNA expression patterns of ERα, ERβ, c-MYC, Bcl-2, and Bax were consistent with the WB results. Conclusion NaAsO₂ inhibits proliferation and promotes apoptosis in Nthy-ori3-1 cells in a dose-dependent manner. The underlying mechanism likely involves NaAsO₂-mediated suppression of the ER-PI3K/AKT signaling pathway, which subsequently regulates downstream proliferation- and apoptosis-related genes.

Objective To assess the intervention effect of nicotinamide mononucleotide (NMN) on the mouse model of hematotoxicity induced by subacute benzene exposure. Methods Benzene exposure and NMN intervention were adopted in a 2×2 factorial design, as benzene exposure and non-exposure, and NMN intervention and non-intervention. Male specific pathogen-free C57BL/6J mice were randomly assigned to negative control group, NMN control group, simple benzene exposure group and NMN intervention group, with 12 mice in each group. Benzene exposure of mice in simple benzene exposure group and NMN intervention group was conducted by dynamic inhalation of benzene at a concentration of 325 mg/m³ for six hours per day, five days per week for four weeks (28 days). Mice in the negative control and NMN control group inhaled clean air. During benzene exposure, mice in the NMN control group and NMN intervention group received NMN in drinking water at a dose of 300 mg/kg body weight. Peripheral blood samples of mice were collected for complete blood count analysis and calculation of composite inflammatory indices after 28 days. Results Interaction analysis showed that the counts of peripheral white blood cell, neutrophil, lymphocyte, and platelet of mice in the simple benzene exposure group were lower than those in the negative control group (all P<0.05). Neutrophil and platelet counts in the NMN intervention group were higher than those in the simple benzene exposure group (all P<0.05). The results of main effect analysis showed that the monocyte count of peripheral blood, systemic inflammatory index, systemic inflammatory response index, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio of mice in the benzene exposure group increased (all P<0.05), and the basophil count and lymphocyte/monocyte ratio decreased (all P<0.05), compared with the control group. Conclusion Oral NMN alleviates subacute benzene-induced decreases in peripheral neutrophil and platelet counts in mice. This protective effect may be related to the targeted intervention of NMN on mitochondrial energy metabolism disorder and oxidative damage induced by benzene exposure in male mice.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To compare the early clinical efficacy of arthroscopic bridge suture combined with strengthening thread fixation for posterior cruciate ligament(PCL)tibial insertion avulsion frac-tures and traditional open double-row anchor suture fixation,and to explore a safe,effective,and min-imally invasive reduction and fixation method for PCL tibial insertion fractures in knee joint under ar-throscopy.Methods This study was a retrospective study.Sixty patients with PCL tibial insertion frac-tures(Meyers&McKeever types II-IV)and admitted to the Department of Orthopedics of Kunming Hospital of Traditional Chinese Medicine between June 2021 and June 2023 were included,and ran-domly divided into a traditional group(age:39.56±3.24 years,male/female:16/14)and a minimally in-vasive group(age:40.32±4.38,male/female:18/12),each of 30,according to their admission or-der.All patients were of Grade III positive in the drawer test before surgery.The traditional group un-derwent posterior medial inlay incision,reduction under direct vision and double-row anchor suture fix-ation,while the minimally invasive group underwent reduction under total arthroscopy,suture-bridge suture at the tendon-bone junction of PCL,and one anchor suture placed at the femoral insertion of PCL,with the anchor suture line serving as the reinforcing suture.Then,the anchor and suture-bridge suture lines were respectively pulled into the two tunnels behind the tibia from the front and then pulled out from the front of the tibia,and the reinforcing suture was knotted in front of the tib-ia.The bridge suture line was fixed in front of the tibia with an external row anchor.Six months after surgery,both groups were evaluated the efficacy using the posterior drawer test and Lysholm score.Re-sults At the follow-up six months after the surgery,both groups had good fracture healing,with one wound infection and delayed healing in the traditional group and total one-stage heal in the other group.According to the physical examination 6 months after surgery,all were negative in the posterior drawer test,except one of degree II positive in the traditional group.Moreover,the average Lysholm score of the traditional group increased from 65.23±3.48 before surgery to 87.64±4.58 points after surgery(P<0.05),while that of the minimally invasive group increased from 64.35±2.52 to 86.82±2.58(P<0.05),showing no significant differences between the two groups(P>0.05).Conclusion Both techniques in this study can achieve excellent surgical outcomes in the treatment of posterior cruciate ligament avulsion fractures at the tibial insertion site.

Objective To analyze the misdiagnosis issues and its contributing factors in 2 cases of failed rescue from severe acute methanol poisoning.Methods Clinical data of the 2 patients who died despite emergency treatment were retrospectively reviewed.Misdiagnosis-related problems were summarized and their root causes were investigated.Results Major misdiagnoses included:① Incomplete and insufficient inquiry of medical history;②Insufficient knowledge of methanol-toxic manifestations;③Failure to scientifically properly interpret arterial blood gas analysis in auxiliary examinations;④Unfamiliarity with methanol poisoning because of its rarity at primary hospitals.The primary causes of misdiagnosis were:①Patients and their families failed to promptly provide a history of methanol poisoning ingestion in a timely manner;② Although the 2 patients were poisoned at the same time,they visited the hospital separately with a time interval of up to 24 hours;③Physicians lacked vigilance and in-depth understanding of the systemic disease mainly characterized by central nervous system damage,visual impairment and metabolic acidosis;④ Physicians made subjective assumptions,had narrow thinking,and lacked the ability to comprehensively analyze the condition.Conclusions Correct diagnosis is the key to reducing the misdiagnosis in the emergency management of severe acute methanol poisoning.Emergency physicians must master the diagnostic criteria of acute methanol poisoning proficiently,and strive for early diagnosis and treatment to improve the prognosis of patients.In addition,public education on poisoning prevention should be strengthened to raise public awareness and reduce the incidence of methanol poisoning.

Objective To develop a task prompt card for critical care records,providing standardized guidance for nurses on record-keeping tasks,reducing record deficiencies caused by forgetfulness,and improving the quality of critical care records.Methods Relevant literature on critical care record was retrieved from the official website of the Chinese government,the official website of the National Health Commission,Wanfang Database,China National Knowledge Infrastructure(CNKI),VIP database,PubMed,Embase,Web of Science,Clinical Key for nursing,Cochrane Library database,and the International Guideline Network.The Joanna Briggs Institute(JBI)literature evaluation tool was used to evaluate the literature.Information related to the construction of critical care record task prompt cards in the literature was extracted to form the expert consultation letter for the Delphi method.According to the research topic and the requirements of the Delphi consultation letter,relevant experts were selected by purposive sampling.The consultation letters were sent to the experts,and after the letters were collected and statistically analyzed,the research team added,modified or deleted the items of the plan according to the experts'opinions and the results of data analysis.The Delphi method was conducted in multiple rounds until the experts'opinions were consistent.Results A total of 14 articles were ultimately included to form the expert consultation letter of the Delphi method.The first round of the Delphi method expert consultation letter contained 5 first-level indicators and 28 second-level indicators.The average score of the first-level indicators in the first round of expert consultation ranged from 4.78-5.00,with a coefficient of variation ranging from 0.00-0.09 and a full score ratio ranging from 77.8%-100.0%.The average score of the second-level indicators in the first round of expert consultation ranged from 3.44-4.89,with a coefficient of variation ranging from 0.00-0.44 and a full score ratio ranging from 33.3%-88.9%.According to the item retention criteria,4 second-level indicators were deleted,8 second-level indicators were modified and 1 second-level indicator was added.The average score of the first-level indicators in the second round of expert consultation ranged from 4.78-5.00,with a coefficient of variation ranging from 0.00-0.09 and a full score ratio ranging from 77.8%-100.0%.The average score of the second-level indicators in the second round of expert consultation ranged from 4.33-5.00,with a coefficient of variation ranging from 0.00-0.16 and a full score ratio ranging from 44.4%-100.0%.After two rounds of the Delphi method,the research team finalised a critical-care record task-reminder card that comprised 5 first-level and 25 second-level indicators.Conclusions The critical-care record task reminder card is an effective tool for preventing critical care nurses from forgetting due to interruption in record tasks,which can lead to errors or omissions in the record content.It can also improve the quality of nursing management.

Objective:To investigate the value of tumor volume to uterine volume ratio (N/U) combined with the expression of alpha-fetoprotein (AFP), sugar antigen 199 (CA199) and human epididymal secretory protein 4 (HE4) in evaluating the pathologic grade and prognosis of endometrial carcinoma (EC) .Methods:A total of 160 EC patients admitted to Linyi Central Hospital from Jan. 2021 to Dec. 2023 were divided into low-grade group and high-grade group according to FIGO grading method, and were divided into poor prognosis group and good prognosis group according to cancer death, recrudescence. The levels of N/U, AFP, CA199 and HE4 in patients with different pathologic grades and prognosis were compared. COX regression was used to analyze the influencing factors of EC adverse prognosis, ROC curve was used to analyze the value of N/U combined with serum AFP, CA199 and HE4 in predicting EC adverse prognosis, and a nomogram model was constructed.Results:Pathological examination of 160 EC patients showed that 12 cases were non-endometrioid adenocarcinoma, 148 cases were endometrioid adenocarcinoma, 41 cases were high-grade and 119 cases were low-grade.According to the follow-up, 94 of the 160 EC patients had good prognosis and 66 had poor prognosis. The levels of N/U, AFP, CA199 and HE4 in the poor prognosis group were higher than those in the good prognosis group ( P<0.05). COX regression analysis showed that high levels of N/U, AFP, CA199 and HE4 were all factors affecting the poor prognosis of EC patients ( P<0.05). The AUC value of combined detection of N/U, AFP, CA199 and HE4 in predicting adverse prognosis of EC patients was higher than that of single detection ( Z=3.140, 3.658, 4.277, 4.378, P<0.05) .The ROC curve AUC (95% CI) of the training set and the validation set were 0.84 (0.77-0.92) and 0.90 (0.81-0.98) respectively for the training set and the validation set to predict the adverse prognosis of EC patients. Calibration curve results showed that the calibration curve for EC patients predicted by the nomogram model was close to the ideal curve ( P=0.521, 0.743). The DCA curve shows that the probability threshold of the nomogram model has a higher positive net return at 20%~100%. Conclusion:The levels of N/U, AFP, CA199 and HE4 in EC patients are related to the pathologic grade, and the combined detection of these indicators can predict the poor prognosis of EC patients, and the nomogram model constructed based on these indicators has high predictive value.

OBJECTIVE: To elucidate the molecular mechanisms underlying sepsis-induced injury in mouse intestinal organoids and investigate the possible mechanisms or potential drug targets of myeloid differentiation factor 88 inhibitor [TJ-M2010-5 (TJ5)] on this condition. METHODS: Small intestinal organoids from C57BL/6 mice aged 6-8 weeks were established and characterized using immunofluorescence for cell growth and proliferation marker nuclear antigen Ki-67, goblet cell marker mucin-2 (MUC-2), epithelial cell marker E-cadherin, and Paneth cell marker lysozyme (Lyz). Small intestinal organoids after 3 days of passaging were divided into different groups: a normal control group treated with culture medium containing 0.2% dimethyl sulfoxide (DMSO) for 10 hours, a lipopolysaccharide (LPS) group treated with culture medium containing 200 mg/L LPS and 0.2% DMSO for 10 hours, and a TJ5 group pre-treated with 10 mmol/L TJ5 for 2 hours followed by treatment with culture medium containing 200 mg/L LPS for 10 hours. Real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-qPCR) was used to measure the expression levels of interleukin-6 (IL-6) and zonula occludens-1 (ZO-1) in the small intestinal organoids. RNA transcriptome sequencing was performed on the small intestinal organoids from each group to analyze differentially expressed genes between groups, and significant enrichment was analyzed using gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). RESULTS: By the 7th day of primary culture, mature organoids had formed, and their growth rate increased after passaging. Immunofluorescence identification showed expressions of Ki-67, MUC-2, E-cadherin, and Lyz, indicating that the mouse small intestinal organoids maintained their cellular composition and functional characteristics under in vitro culture conditions. RT-qPCR results showed that compared with the normal control group, the mRNA expression of IL-6 in the small intestinal organoids of the LPS group was significantly increased (2^-ΔΔCT: 1.83±0.16 vs. 1.02±0.28, P < 0.05), while the mRNA expression of ZO-1 was significantly decreased (2^-ΔΔCT: 0.53±0.11 vs. 1.01±0.18, P < 0.05). In contrast, the mRNA expression trends of both IL-6 and ZO-1 were reversed in the TJ5 group, showing statistically significant differences as compared with the LPS group (2^-ΔΔCT: IL-6 mRNA was 1.24±0.01 vs. 1.83±0.16, ZO-1 mRNA was 1.97±0.29 vs. 0.53±0.11, both P < 0.05). RNA transcriptome sequencing showed 49 differentially expressed genes in the LPS group compared to the normal control group, with 42 upregulated and 7 downregulated. Compared to the LPS group, the TJ5 group showed 84 differentially expressed genes, with 47 upregulated and 37 downregulated. GO enrichment analysis of these differentially expressed genes showed that the significantly enriched biological processes of the differentially expressed genes between the normal control group and the LPS group included responses to LPS, responses to molecule of bacterial origin and responses to bacterium. The significantly enriched biological processes of the differentially expressed genes between the LPS group and the TJ5 group included glutathione metabolic processes, responses to stress cellular and responses to chemical stimulus. In molecular function groups, glutathione binding and oligopeptide binding were significantly enriched by the differentially expressed genes. In cellular component classifications, the enrichment of the differentially expressed genes was mainly observed in the cytoplasm, endoplasmic reticulum, and microsomes. KEGG pathway enrichment analysis indicated that the differentially expressed genes between the normal control group and LPS group were enriched in IL-17 signaling pathways, tumor necrosis factor (TNF) signaling pathways, viral protein interactions with cytokines and cytokine receptors signaling pathways, and cytokine-cytokine receptor interaction signaling pathways. In contrast, the differentially expressed genes between the LPS and TJ5 groups were mainly enriched in atherosclerosis signaling pathways, ferroptosis signaling pathways, glutathione metabolism signaling pathways, and cytochrome P450-mediated drug metabolism signaling pathways. CONCLUSIONS Mouse small intestinal organoids were successfully extracted and cultured. TJ5 may exert its protective effects by regulating gene expression and related signaling pathways (fluid shear stress and atherosclerosis, ferroptosis, glutathione metabolism, cytochrome P450 drug metabolism, etc.) in sepsis-injured mouse small intestinal organoids. These genes and signaling pathways may be key targets for treating sepsis-induced intestinal injury.
Animals ; Mice ; Sepsis/genetics* ; Organoids/drug effects* ; Mice, Inbred C57BL ; Intestine, Small/metabolism* ; Gene Expression Profiling ; Transcriptome ; Lipopolysaccharides

Objective To investigate the predictive ability of cyst fluid characteristics for malignant intraductal papillary mucinous neoplasms (IPMNs). Methods We prospectively collected fresh cyst fluid from patients undergoing pancreatic resection at the Department of Hepatobiliary Pancreatic Spleen Surgery, Changhai Hospital, Shanghai, from September 2023 to December 2024, who were ultimately pathologically confirmed with IPMN. We assessed the characteristics of cyst fluid, including viscosity, clarity, and color, and explored its predictive performance for benign or malignant. Results A total of 40 patients with IPMN were included. The sensitivity of the string sign （+） for diagnosing high-grade dysplasia/ invasive carcinoma （HGD/IC） was 90.9%, specificity was 92.9%, and accuracy was 76.0%. The cyst fluid of intestinal-type IPMN often exhibited a gelatinous consistency, and there was no significant difference in the distribution of gelatinous consistency between the HGD/IC group and the low-grade dysplasia （LGD） group. There were no significant differences in CEA, glucose, and amylase levels in the cyst fluid between the HGD/IC group and the LGD group. Conclusions The characteristics of pancreatic cyst fluid, especially viscosity, can effectively predict the benign or malignant nature of IPMN.