Fungal keratitis represents a significant cause of blindness, with current therapeutic approaches yielding limited success. The disease's onset and progression are primarily driven by fungal virulence factors and the host's immune response. The innate immune system is the first to respond, with neutrophils playing a pivotal role in the antifungal defense. Although neutrophils are critical for pathogen clearance, their excessive or abnormal activation can lead to tissue damage, exacerbating the disease. Thus, elucidating the mechanisms underlying neutrophil activity in fungal keratitis is crucial for refining treatment strategies. This article aims to systematically review the principal antimicrobial mechanisms employed by neutrophils, including phagocytosis, degranulation, and the formation of neutrophil extracellular traps(NETs). Furthermore, it explores the crosstalk between neutrophils and macrophages, alongside their collective impact and underlying mechanisms in the context of fungal keratitis. Exploration of the mechanisms of fungal keratitis facilitates precise intervention and enhances the efficacy of treatment.

Fungal keratitis is a serious blinding eye disease. The development of fungal infections depends primarily on the interaction of fungal virulence with host immune defense factors. The cornea is considered an immune-privileged organ, and resident macrophages are the main immune cells that respond to the heterogeneity exhibited by the microenvironment with their polarization. In the early stage of infection, macrophages polarize towards M1, which promotes inflammation and facilitates fungal clearance but produces a cellular storm that exacerbates immune damage; in the late stage of infection, macrophages polarize towards M2, which suppresses the inflammatory response and facilitates tissue repair, but may be immunosuppressed or even immune escape to the detriment of pathogen clearance. The balance between pro-inflammatory and anti-inflammatory responses is key to maintaining the functional integrity of the cornea. Current antifungal drug therapy is limited, so it is particularly important to find a therapeutic target for the inflammatory response triggered by the immune response in addition to antifungal therapy. In this review, the functional and phenotypic characterization of macrophage subsets associated with fungal keratitis was reviewed, more in-depth research is needed to explore the specific mechanisms by which macrophage polarization and their impact on fungal keratitis. Targeted regulation of macrophage differentiation based on their phenotype and function could be an effective approach to treat and manage fungal keratitis in the future.

Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.

Objective:To evaluate the safety and efficacy of the neoadventitia technique for root repair in acute type A aortic dissection(ATAAD).Methods:From January 2019 to February 2022, a total of 94 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital were retrospectively analyzed. According to the different treatment methods for the aortic root, the patients were divided into the neoadventitia technique group(58 cases) and the Bentall group(36 cases). The perioperative data and postoperative follow-up results of the two groups were compared, and the efficacy of the new adventitia technique in acute type A aortic dissection was analyzed.Results:There were no intraoperative deaths. The 30-day mortality was 3.4% and 5.6% in the neoadventitia group and Bentall group, respectively ( P=0.636). The cardiopulmonary bypass time[(154.3±29.8)min, P<0.001] and aortic clamp time[(94.7±20.6)min, P<0.001)]were significantly shorter in the neoadventitia group, compared with the Bentall group. Aortic regurgitation was significantly improved after the operation (0.33±0.50 vs. 1.02±0.80, P<0.001). No aortic root-related secondary intervention occurred during follow-up. There was no significant difference in mortality between the two groups( P=0.248). Conclusion:Neoadventitia root repair is a safe and feasible method for the treatment of ATAAD, which has good short-term and mid-term efficacy.

Objective : To investigate the expression of programmed death 1 (PD1) on CXCR5 - CD4 + T cells from the patients with systemic lupus erythematosus ( SLE) and to analyze the clinical relevance to disease severity. Methods : The expression of PD1 on CXCR5 - CD4 + T cells was examined from 47 SLE patients and 35 healthy controls (HC) by the technique of flow cytometry. The expression of PD1 including percentage of PD1 + CXCR5 -CD4 + T cells and mean fluorescence intensity (MFI) on CXCR5 - CD4 + T cells was compared between SLE patients and HC. And its correlation with clinical indicators , laboratory inspection and the percentage of plasmablasts was analyzed. Moreover, the predictive value of the expression of PD1 on CXCR5 - CD4 + T cell was explored. Results: ① The percentage of PD1 + CXCR5 - CD4 + T cells from SLE patients significantly elevated compared with HC (P= 0. 008 3 , U = 540. 5) , and the MFI of PD1 on CXCR5 - CD4 + T cells from SLE patients significantly elevated compared with HC (P < 0. 000 1 , U = 187. 0) . ② The percentage of PD1 + CXCR5 - CD4 + T cells was associated with C3 ( rs = - 0. 335 2 , P = 0. 022 8) , anti - SSA (P = 0. 016 6 , t = 2. 5) , anti - histone (P = 0. 030 3 , t =2. 3) , treatment (P = 0. 020 2 , t = 3. 4) , plasmablasts ( rs = 0. 387 1 , P = 0. 0072) in SLE patients. The MFI of PD1 on CXCR5 - CD4 + T cells was associated with SLEDAI ( rs = 0. 403 1 , P = 0. 005 0) , ESR ( rs = 0. 356 1 , P= 0. 017 7) , CRP ( rs = 0. 337 4 , P = 0. 028 9) , RBC ( rs = - 0. 297 0 , P = 0. 042 6) , HGB ( rs = - 0. 302 9 , P= 0. 038 5) , HCT ( rs = - 0. 381 6 , P = 0. 008 1) , L ( rs = - 0. 393 7 , P = 0. 006 2) , L% ( rs = - 0. 391 2 , P= 0. 006 5) , N% ( rs = 0. 315 0 , P = 0. 031 1) , NLR ( rs = 0. 373 0 , P = 0. 009 8) , LMR ( rs = - 0. 431 5 , P =0. 002 5) , dNLR ( rs = 0. 315 0 , P = 0. 031 1) , anti⁃Ro52 (P = 0. 029 5 , t = 63. 5) , treatment (P = 0. 035 5 , W= 21) , plasmablasts ( rs = 0. 315 8 , P = 0. 030 6) . ③ Logistic regression analysis showed that the MFI of PD1 on CXCR5 - CD4 + T cells was a risk factor for SLE. ④ ROC analysis showed the AUC of the MFI of PD1 on CXCR5 -CD4 + T cells was 0. 886. A further established model based on combination of the MFI of PD1 on CXCR5 - CD4 + T cells and HGB showed predictive value in distinguishing SLE from HC with AUC of 0. 979. And predictive value was positively associated with SLEDAI ( rs = 0. 313 6 , P = 0. 030 3) . Conclusion Increased percentage of PD1 + CXCR5 - CD4 + T cells and increased MFI of PD1 on CXCR5 - CD4 + T cells in SLE are associated with disease severity and activity , and a model based on combination of the MFI of PD1 on CXCR5 - CD4 + T cells and HGB shows prominent value for predicting SLE.

Objective:To evaluate the efficacy of new arch-clamping technique in Sun’s procedure to repair acute type A aortic dissection.Methods:67 consecutive patients with acute type A aortic dissection who underwent total arch replacement and frozen elephant trunk implantation(TAR+ FET) from Dec 2019 to Dec 2022 with using new arch-clamping technique during operation. Relative intraoperative and postoperative variables and complications were compared.Results:Cardiopulmonary bypass time was(166.66±32.81)min, the aortic occlusion time was(100.49±19.96)min, the circulatory arrest time was(3.97±1.63)min, the lowest nasopharyngeal temperature was(25.716±1.304)℃, and the lowest bladder temperature was(26.209±1.552)℃. The whole group died in hospital in 2 cases(2.98%), cerebral infarction in 3 cases(4.48%), transient neurological dysfunction in 4 cases(5.97%), paraplegia patients in 1 case(1.49%), renal failure requiring continuous dialysis in 4 cases(5.97%).Conclusion:New arch-clamping technique decrease postoperative complication, and is a safe and feasible innovative approach to effectively improve surgical outcome of Sun’s procedure for repair of acute type A aortic dissection.

Objective : To investigate the expression of programmed death 1 (PD1) on CXCR5 －CD4 + T cells from the patients with rheumatoid arthritis (RA) and to analyze the clinical relevance to disease severity． Methods : The expression of PD1 on CXCR5 －CD4 + T cells were examined from 82 RA patients and 46 healthy controls (HC) by the technique of flow cytometry．The expression of PD1 including mean fluorescence intensity (MFI) on CXCR5 - CD4 + T cells and percentage of PD1 + CXCR5 －CD4 + T cells were compared between RA patients and HC．Moreo- ver，its correlation with laboratory inspection was analyzed. Results : ① The percentage of PD1 + CXCR5 －CD4 + T cells and the MFI of PD1 on CXCR5 －CD4 + T cells from RA patients were significantly elevated compared with HC (P＜0. 000 1，U = 1 082 ; P ＜0. 000 1 ，U = 917. 5) . ② The percentage of PD1 + CXCR5 － CD4 + T cells in RA patients were positively associated with rheumatoid factors (RF) (rs = 0. 267 9，P = 0. 022 9) ，increased RF (rs = 0. 419，P = 0. 001 1) ，increased anti-cyclic citrullinated peptide (anti-CCP) (rs = 0. 260 7，P = 0. 040 7) ，the percentage of plasmablasts (rs = 0. 302 4，P = 0. 029 3) ，DAS28-ESR (rs = 0. 244 7，P = 0. 042 7) . ③ The MFI of PD1 on CXCR5 －CD4 + T cells in RA patients were negatively with lymphocytes number (rs = －0. 338 7，P = 0. 002 0 ) ，lymphocytes percentage ( rs = －0. 347 9 ，P = 0. 001 4 ) ，lymphocyte-to-monocyte ratio ( rs = - 0. 263 7，P = 0. 017 4) ．The MFI of PD1 on CXCR5 － CD4 + T cells in RA patients were positively associated with neutrophil percentage ( rs = 0. 304 7 ，P = 0. 005 4 ) ，neutrophilto-lymphocyte ratio ( rs = 0. 341 1 ，P = 0. 001 8) ，platelet-to-lymphocyte ratio (rs = 0. 232 1，P = 0. 037 1) ，systemic immune inflammation index (rs = 0. 288 0，P = 0. 009 1) ，derived Neutrophil to lymphocyte ratio ( rs = 0. 320 3，P = 0. 003 6) ，erythrocyte sedi- mentation rate (rs = 0. 259 5，P = 0. 019 3) ，patient visual analogue scale (rs = 0. 241 6，P = 0. 043 9) ．The MFI of PD1 on CXCR5 － CD4 + T cells from high active RA patients was significantly elevated compared with non-high active group (P = 0. 040 7，U = 406. 0) ． Conclusion The abnormal expression of PD1 on CXCR5 －CD4 + T cells are observed in patients with RA．Increased expression of PD1 on CXCR5 － CD4 + T cells are associated with the production of antibody，the percentage of plasmablasts，inflammation，and also disease activity.

Aortic aneurysm (AA) is a vascular disease involving the progressive dilation of aorta diameter. It is usually asymptomatic but with high mortality once rupture. Currently, there is no effective pharmacologic treatment. MicroRNA specifically refers to non-coding small RNAs consisting of 19-25 nucleotides. The characteristic of microRNA targeting multiple genes seems to form a complicated regulation network, which receives considerable attention. Emerging studies show that microRNAs are closely related to the occurrence and development of AA. Many microRNAs are involved in multiple cell processes and functions and may participate in the pathogenesis of AA, including endothelial cell dysfunction, inflammatory cell infiltration, smooth muscle cell apoptosis, and extracellular matrix degradation. This article will describe the animal models for AA research and the latest progression of microRNA and AA.

Objective:To investigate the implementation effect of micro-video assisted physiological theory teaching based on functional experiments.Methods:There were 140 clinical undergraduates (control group) from Class 1 and Class 2, and 123 clinical undergraduates (experimental group) from Class3 and Class 4 of Batch 2017 in our university who were involved in this study. The control group adopted traditional teaching method, the experimental group adopted micro-videos to assist traditional teaching in the teaching of selected chapters, and these micro-videos were collected from the recording and editing of functional experiments. After the course, questionnaire survey in terms of course design, implementation and effect, as well as final exanimation performance analysis were conducted to evaluate the teaching effect. SPSS 17.0 was used for t test. Results:The final examination scores of the experimental group were significantly higher than those of the control group [(81.02±9.64) vs. (73.41±11.39)], with significant differences ( t=-5.805, P<0.001). Among them, the scores of Chapter 2 of the two groups were [(8.07±0.94) vs. (6.14±1.05), t=-15.616, P<0.001)], the scores of Chapter 4 were [(16.16±1.79) vs. (10.90±2.23), t=-20.903, P<0.001)], and the scores of Chapter 6 were [(6.04±0.53) vs. (5.82±0.78), t=-2.638, P=0.009)], all with significant differences. 100% of questionnaires were recovered, and more than 90% of students were interested in this teaching method which could strengthen their understanding of the key and difficulties in physiology and was also helpful to cultivate their ability of induction and summarization. Conclusion:Micro-videos based on functional experiments assisted teaching can improve the teaching effect of physiology, and it's worth popularizing.

Objective To evaluate the short-term efficacy of recombinant human endostatin (rhES) combined with transcatheter arterial chemoembolization (TACE) versus TACE alone for intermediate and advanced primary hepatic carcinoma.Methods The relevant controlled trials about rhES plus TACE versus TACE alone in the treatment of intermediate and advanced primary hepatic carcinoma were retrieved from the databases of PubMed,Elsevier,Cochrane Library,China National Knowledge Infrastructure (CNKI),Chinese Biomedical Literature Database (CBM),Wan Fang Database.The retrieval time limited was from the database construction to January 2018,and the Meta-analysis was performed by using RevMan5.3 software.Results 18 controlled trials were included in this Meta-analysis.There were 948 cases,of which 522 cases in rhES plus TACE group and 426 cases in TACE alone group.According to the usage of rhES,the trials were further divided into intrahepatic arterial embolization group,intrahepatic arterial pump group,and intravenous infusion group.rhES plus TACE had an overall advantage over TACE alone in terms of objective response rate (ORR),and the difference was statistically significant (RR =1.59,95％CI:1.41～1.79,P＜0.05).And the ORR of rhES plus TACE in intrahepatic arterial embolization group,intrahepatic arterial pump group,intravenous infusion group was better than that of TACE alone (Intrahepatic arterial embolization group RR=1.63,95％CI:1.36～ 1.95;Intrahepatic arterial pump group RR=1.49,95％CI:1.24～1.79;Intravenous infusion group RR=1.69,95％CI:1.22～2.34),and the difference was statistically significant (P＜0.05).The subgroups analysis of anthracycline and platinum also showed that ORR in rhES plus TACE patients was better than that in TACE patients alone.Conclusion The short-term efficacy of rhES plus TACE in the treatment of intermediate and advanced primary hepatic carcinoma was better than that of TACE alone,and the same results were obtained by subgroup analysis.