Phacoemulsification represents the mainstream, efficient, and safe surgical modality for cataract treatment, and continuous technological advances have further improved the safety profile of this procedure in ordinary patients. However, patients with high myopia feature inherent anatomical abnormalities of the eyeball, leading to a fundamental incompatibility with conventional phacoemulsification protocols. Such patients face a markedly elevated risk of both anterior and posterior segment perioperative complications, posing a persistent clinical challenge in cataract surgery. Focusing on the unique ocular anatomical characteristics associated with high myopia, this review systematically summarizes the distinct traumatic effects and pathological impacts of phacoemulsification on the anterior and posterior ocular segments of affected patients. Moving beyond generalized discussions of routine cataract management, it consolidates clinical evidence specific to this special-population patients, aiming to provide refined references for perioperative risk prevention and control in cataract patients complicated with high myopia.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective:To investigate the effects and molecular mechanisms of Wilms tumor 1-associated proteins(WTAP)on the cell biological properties of esophageal squamous cell carcinoma(ESCC)cells.Methods:31 pairs of ESCC tissues and their paired paracancerous tissues that were surgically resected at the Second Clinical Medical College of Chuanbei Medical College between September 2019 and April 2021 were collected.The esophageal cancer cells KYSE30,KYSE410,KYSE150,KYSE510,TE-1,and normal human esophageal epithelial cells HET-1A were routinely cultured.Transfection reagents were used to transfect si-NC,si-WTAP#1 and si-WTAP#2 nucleic acids into KYSE150 and KYSE510 cells.The cells were divided into si-NC,si-WTAP#1 and si-WTAP#2 groups.The expressions of WTAP and MAP3K9 mRNA were detected in the cells of each group by qPCR assay.CCK-8 assay,clone formation assay,and scratch healing assay,Transwell assay were employed to detect the effects of knockdown of WTAP expression on ESCC cell proliferation,migration,invasion and apoptosis.WB assay was used to detect the expressions of WTAP,MAP3K9,EMT and MAPK pathway-related proteins in ESCC cells of each group knocked down of WTAP;immunohistochemistry to detect the expression of WTAP proteins in ESCC tissues,immunoprecipitation of methylated RNA(MeRIP)-qPCR assay to detect the level of MAP3K9 m6A in ESCC cells,actinomycin D assay to detect the stability of mRNA of MAP3K9,and database data to analyze the expression,target genes,functional enrichment,and interacting RNA of WTAP.Results:WTAP was highly expressed in ESCC tissues and cells(P<0.05 or P<0.01 or P<0.001)and correlated with the degree of differentiation(P<0.01);the expression of WTAP mRNA and its protein were successfully knocked down in KYSE150 and KYSE510 cells(P<0.01 or P<0.001);the knockdown of WTAP significantly inhibited the proliferation,migration and invasion of KYSE150 and KYSE510 cells(P<0.05 or P<0.01 or P<0.001),and promoted the apoptosis of KYSE150 and KYSE510 cells(P<0.05 or P<0.01).Knockdown of WTAP resulted in a significant decrease in the m6A level of MAP3K9(P<0.05),and its mRNA expression level and mRNA stability were both significantly reduced(P<0.05).Database data analysis showed that WTAP target genes clustered in the MAPK signaling pathway;the expression levels of MAP3K9,p-ERK,N-cadherin,and MMP9 were significantly reduced(P<0.05 or P<0.01),and the expression level of E-cadherin was significantly elevated(P<0.05 or P<0.01)in the KYSE150 and KYSE510 cells after knockdown of WTAP.Conclusions:WTAP is highly expressed in ESCC tissues and cells and correlates with their differentiation.It promotes the stability of MAP3K9 mRNA through m6A modification,activates the MAPK pathway and thus promotes the malignant biological behaviors of ESCC cells.

Objective:To investigate the clinicopathological characteristics and the application of ATRX(alpha-thalassemia mental retardation X-linked)in hepatic angiosarcoma.Methods:We retrospectively analyzed the pathological and clinical data of seven patients diagnosed with hepatic angiosarcoma at the Department of Pathology, Beijing Hospital, between 2014 and 2023.ATRX immunohistochemical staining was conducted.Results:Among the patients, six were identified incidentally during physical examinations, while only one patient presented with abdominal pain.Six patients had multiple nodules, whereas one had a solitary tumor.The morphological features were diverse; high-grade angiosarcoma exhibited liver plate atrophy and hepatic sinusoids lined with atypical cells, while low-differentiated angiosarcoma displayed a higher degree of atypia and should be differentiated from other sarcomas.Tumor cells expressed vascular endothelial markers, including CD31(platelet endothelial cell adhesion molecule-1), CD34(hematopoietic progenitor cell antigen CD34), and ERG(Ets-related gene).Additionally, loss of ATRX expression was observed in four patients.Conclusions:Hepatic angiosarcoma is characterized by a lack of specific clinical manifestations and imaging findings.A comprehensive analysis of clinical symptoms, morphological features, and immunohistochemical staining—particularly for vascular markers and ATRX—is essential for an accurate pathological diagnosis.

Occupational noise-induced hearing loss (NIHL) is an irreversible sensorineural hearing loss that severely endangers workers’ health, making early screening crucial. This article reviewed the research progress on early screening methods for occupational NIHL, introduced the testing mechanisms of three core screening methods—tympanometry, otoacoustic emissions, and extended high-frequency audiometry —and summarized their clinical application advantages and limitations. It is proposed that multimodal combined detection (e.g., the combination of tympanometry, otoacoustic emissions, and extended high-frequency audiometry) can significantly improve the accuracy and comprehensiveness of early screening. Meanwhile, future studies with prospective cohort design are encouraged to verify the long-term monitoring value of each method and to strengthen the joint development of screening technologies with cutting-edge approaches such as machine learning, in order to further improve screening efficiency and provide stronger protection for workers’ hearing health.

Objective:To investigate the current application of blood purification in the treatment of acute poisoning within Jiangsu Province and to evaluate the impact of extracorporeal blood purification on the clinical outcomes of critically poisoned patients.Methods:This multicenter, cross-sectional real-world observational study followed patients presenting with poisoning to the emergency departments of nine hospitals in Jiangsu Province between June 2015 and May 2019. Data were collected on demographic characteristics, vital signs within the first hour of emergency presentation, treatment modalities, length of hospital stay, and survival outcomes. Clinical data from patients who underwent extracorporeal blood purification were compared with those who did not, using the Wilcoxon rank-sum test and Chi-square test.Results:A total of 4 178 poisoning cases were included between June 2015 and May 2019. Among them, 21.7% (908/4 178) received blood purification therapy, while 78.3% (3 270/4 178) did not. Hemoperfusion (90.4%) was the most frequently employed method, followed by continuous renal replacement therapy (CRRT) (4.4%). In combined blood purification modalities, 4.8% underwent hemoperfusion combined with CRRT, 0.1% received hemoperfusion with plasma exchange, and another 0.1% underwent hemoperfusion combined with both CRRT and plasma exchange. Among patients who underwent blood purification, pesticide poisoning was the most prevalent (76.3%), with the most common toxic agents being paraquat (23.7%), dichlorvos (8.7%), methamidophos (5.2%), omethoate (4.0%), and glyphosate (3.7%). Compared to the non-blood purification group, patients in the blood purification group were more likely to present within the first hour with a low Glasgow Coma Scale (GCS) score (3-8) (22.6% vs. 9.7%, P <0.05), low mean arterial pressure (8.0% vs. 3.2%, P <0.05), longer hospital stays [5(3,9) days vs. 2(1,4) days, P <0.05] and a higher in-hospital mortality rate (21.1% vs. 5.3%, P <0.05). Follow-up via telephone 28 days after discharge revealed a survival rate of 78.9%, with a mortality rate of 21.1% in the blood purification group. Conclusions:Hemoperfusion is the most commonly utilized blood purification technique for treating poisoning in Jiangsu Province, with pesticides being the primary toxic agents treated. Although the mortality rate is higher in the blood purification group, the intervention may still contribute to improved patient outcomes.

AIM: To design and construct recombinant epitope nucleotides vaccine of glycoprotein B(gB)and glycoprotein D(gD)of herpes simplex virus type 1(HSV-1), and to investigate its immunoprotective effects and tissue expression in animal models.METHODS: The HSV-1 gB and gD epitope genes were selected and tandem assembled to construct the recombinant protein-coding gene X, which was transducted into the prokaryotic expression vector pET28(a). The recombinant protein was synthesized and utilized to generate monoclonal antibodies, which were subsequently used to immunize New Zealand white rabbits. The immunogenicity of the purified protein and the presence of polyclonal antibodies in the serum were tested through separating serum from cardiac blood, and the serum antibody titers were determined. The pcDNA3.1-X was successfully constructed as a eukaryotic expression vector and immunized the female BALB/c mice aged 4 to 6 wk via intramuscular injection. Serum antibodies and immune-related cytokines were quantified using enzyme-linked immunosorbent assay(ELISA). The expression of the X protein in the ocular, trigeminal ganglion, and brain tissues of the mice was assessed.RESULTS: The target polyclonal antibody was identified with a serum antibody titer of 1:3200 in the rabbit serum after immunized by recombinant protein X. Upon immunizing mice with the eukaryotic recombinant plasmid pcDNA3.1-X, the concentration of HSV-1 serum IgM antibodies of the experimental group was 12.13±0.85 ng/L, which was significantly higher than that of the vector control group(0.49±0.44 ng/L; t=21.07, P<0.001). The concentrations of cytokines interleukin IL-2, IL-4, IL-10, and IFN-γ in the experimental group were 11.63±0.60, 22.65±1.47, 85.75±14.12, and 114.90±6.39 ng/L, respectively, all of which were significantly higher than those in the vector control group and the blank control group(all P<0.05). Immunohistochemical staining revealed the presence of target protein X in the eyeball, trigeminal ganglion, and brain tissue.CONCLUSION: The HSV-1 gB and gD tandem epitope nucleotides vaccine pcDNA3.1-X was successfully constructed, which activates a remarkable immune response and is stably expressed in the eyeball, trigeminal ganglion, and brain tissue. This study provides a foundation for further research of an HSV-1 recombinant antigen epitope tandem vaccine.

Objective:To evaluate the short-term clinical outcomes of minimally invasive surgery for severe hallux valgus deformity using absorbable screw fixation.Methods:This retrospective study included 35 patients with severe hallux valgus deformities treated with third-generation minimally invasive Chevron and Akin osteotomies (MICA) using absorbable screws at the Foot and Ankle Surgery Department of Guangzhou Orthopedic Hospital from January 2022 to January 2023. The cohort consisted of 2 males and 33 females, with an average age of 56.75±13.27 years (ranging from 20 to 72 years).There were 18 cases of left foot and 17 of right. Preoperative and 12-month postoperative radiographic and clinical data were collected and analyzed. Radiographic evaluations included measurements of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) on weight-bearing foot X-ray films. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the visual analogue scale (VAS) for pain. All complications during follow-up were recorded to comprehensively assess surgical outcomes and safety.Results:All the 35 cases successfully underwent the surgery, with a surgery time of 61.5±3.2 minutes and intraoperative blood loss of 5.4±1.2 ml. No patients lost follow-up, with a mean follow-up of 15.65±2.48 months (ranging from12 to 19 months). At the final follow-up, the AOFAS score significantly improved from 39.8±4.7 preoperatively to 92.3±4.1 postoperatively ( P<0.05), and the VAS significantly decreased from 8.7±1.2 to 1.8±0.8 ( P<0.05). The HVA decreased from 42.5°±4.1° to 12.5°±3.7° ( P<0.05), and the IMA decreased from 18.5°±2.8° to 7.3°±2.1° ( P<0.05). Radiographic follow-up demonstrated complete osseous union at the osteotomy sites in all cases, with no complications of nonunion or displacement. 7 patients with concurrent gastrocnemius tightness underwent gastrocnemius release, and 11 patients with associated transfer metatarsalgia were treated with Weil osteotomy ( n=8) or metatarsal head recontouring ( n=3), achieving satisfactory outcomes for all cases. Complications were minimal, with 2 cases of localized numbness around the surgical incision observed on postoperative day 3; the symptoms were gone spontaneously 3 months postoperatively. No other major complications, such as infection, hematoma, or neurovascular injury, were observed. Conclusion:Minimally invasive surgery using absorbable screw fixation effectively improves clinical function and symptoms in patients with severe hallux valgus deformities without any major complications, suggesting that it is a safe and effective treatment option.

Objective:To investigate the therapeutic efficacy of proximal ulnar osteotomy combined with autologous iliac bone grafting for the repair of chronic elbow varus with posteromedial rotational instability caused by coronoid process bone defects.Methods:A retrospective analysis was conducted on the data of 9 male patients with chronic elbow varus and posteromedial rotational instability caused by coronoid process bone defects who were treated with proximal ulnar osteotomy combined with autologous iliac bone grafting at Sichuan Provincial Orthopaedic Hospital from January 2017 to May 2024. The patients' ages ranged from 20 to 46 years, with an average of 29.78±8.77 years old. There were 3 cases on the right side and 6 on the left side. The height of the bone defect on the anteromedial surface of the coronoid process ranged from 5.24 to 12.23 mm, with an average of 9.01±2.61 mm. The time from injury to surgery ranged from 5 to 9 months, with an average of 6.78±1.39 months. During the operation, proximal ulnar osteotomy combined with autologous iliac bone grafting was used to repair the coronoid process bone defect. Simultaneously, the lateral ulnar collateral ligament was reconstructed using the suture anchors (3 patients) or repaired with autologous palmaris longus tendon (6 patients). Finally, a hinged external fixator was applied in all cases. The range of motion (ROM) of the elbow joint was recorded before and after the surgery. The visual analogue score (VAS) was used to evaluate the degree of pain, and the Mayo elbow performance score (MEPS) was employed to assess the elbow joint function.Results:All surgical incisions healed primarily, and no case of infection occurred. All 9 patients were followed up, with a follow-up period ranging from 11 to 25 months, and an average of 17.78 ± 5.16 months. The bone grafts all healed, with a healing time ranging from 3 to 5 months, and an average of 3.56±0.73 months. The elbow extension angles before surgery, at 6 months postoperatively, and at the last follow-up were 24.44°±14.24°, 11.11°±9.28°, and 2.22°±4.41°, respectively. The flexion angles were 118.89°±5.46°, 123.33°±5.00°, and 128.89°±3.33°, respectively. The flexion-extension ROMs were 94.44°±18.28°, 112.22°±13.02°, and 126.67°±7.07°, respectively. The pronation angles were 61.67°±6.12°, 61.67°±3.54°, and 67.22°±5.07°, respectively. The differences in these angles were all statistically significant ( P<0.05). The supination angles before surgery, at 6 months postoperatively, and at the last follow-up were 77.22°±7.55°, 78.89°±6.01°, and 79.44°±6.35°, respectively. The rotational ROMs were 138.89°±11.93°, 140.56°±7.26°, and 146.67°±10.31°, respectively. No statistically significant differences were observed ( P>0.05). The VAS scores before surgery, at 6 months postoperatively, and at the last follow-up were 6.89±0.78 points, 2.33±1.00 points, and 0(0, 0.5) points, respectively, and the difference was statistically significant ( H=23.216, P<0.001). The MEPS scores were 42.22±5.65 points, 76.67±7.05 points, and 95.00±7.50 points, respectively, and the difference was also statistically significant ( F=134.212, P<0.001). The cantilever test confirmed that none of the patients had elbow joint instability symptoms, and the patients were satisfied with the treatment effect. Conclusions:Proximal ulnar osteotomy combined with autologous iliac bone grafting, simultaneous repair or reconstruction of the lateral ligament complex, and fixation with a hinged external fixator is an effective treatment approach for chronic elbow varus with posteromedial rotational instability. This method can alleviate elbow pain, improve the ROM, and enhance elbow function in patients, yielding satisfactory short-term outcomes.

Objective:To evaluate the short-term clinical outcomes of minimally invasive surgery for severe hallux valgus deformity using absorbable screw fixation.Methods:This retrospective study included 35 patients with severe hallux valgus deformities treated with third-generation minimally invasive Chevron and Akin osteotomies (MICA) using absorbable screws at the Foot and Ankle Surgery Department of Guangzhou Orthopedic Hospital from January 2022 to January 2023. The cohort consisted of 2 males and 33 females, with an average age of 56.75±13.27 years (ranging from 20 to 72 years).There were 18 cases of left foot and 17 of right. Preoperative and 12-month postoperative radiographic and clinical data were collected and analyzed. Radiographic evaluations included measurements of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) on weight-bearing foot X-ray films. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the visual analogue scale (VAS) for pain. All complications during follow-up were recorded to comprehensively assess surgical outcomes and safety.Results:All the 35 cases successfully underwent the surgery, with a surgery time of 61.5±3.2 minutes and intraoperative blood loss of 5.4±1.2 ml. No patients lost follow-up, with a mean follow-up of 15.65±2.48 months (ranging from12 to 19 months). At the final follow-up, the AOFAS score significantly improved from 39.8±4.7 preoperatively to 92.3±4.1 postoperatively ( P<0.05), and the VAS significantly decreased from 8.7±1.2 to 1.8±0.8 ( P<0.05). The HVA decreased from 42.5°±4.1° to 12.5°±3.7° ( P<0.05), and the IMA decreased from 18.5°±2.8° to 7.3°±2.1° ( P<0.05). Radiographic follow-up demonstrated complete osseous union at the osteotomy sites in all cases, with no complications of nonunion or displacement. 7 patients with concurrent gastrocnemius tightness underwent gastrocnemius release, and 11 patients with associated transfer metatarsalgia were treated with Weil osteotomy ( n=8) or metatarsal head recontouring ( n=3), achieving satisfactory outcomes for all cases. Complications were minimal, with 2 cases of localized numbness around the surgical incision observed on postoperative day 3; the symptoms were gone spontaneously 3 months postoperatively. No other major complications, such as infection, hematoma, or neurovascular injury, were observed. Conclusion:Minimally invasive surgery using absorbable screw fixation effectively improves clinical function and symptoms in patients with severe hallux valgus deformities without any major complications, suggesting that it is a safe and effective treatment option.