Cataract surgery is one of the most common ophthalmologic procedures. Advances in technology and medical policies have made it more precise. Residual refractive errors and deviation of target diopters are a main cause of dissatisfaction among patients. Refractive enhancement after cataract surgery can correct or eliminate these errors, improving patients' visual quality of life. There are multiple options for correcting residual refractive errors. The best approach depends on factors like the cause of the error, degrees of residual refractive errors, type of intraocular lens, ocular comorbidities, and patient preference. This paper summarizes the incidence and types of residual refractive errors, advancements in refractive enhancement surgeries, and provides practical solutions for clinical practice.

Objective To investigate the perioperative differences between video-assisted thoracoscopic surgery (VATS) and thoracotomy after neoadjuvant therapy in patients with non-small cell lung cancer (NSCLC). Methods Clinical data of NSCLC patients who underwent VATS or thoracotomy after neoadjuvant therapy at Shanghai Pulmonary Hospital from June 2020 to May 2022 were retrospectively collected. Perioperative outcomes were compared between the two groups. Results A total of 260 patients were enrolled, 184 (70.8%) patients underwent VATS and 76 (29.2%) patients underwent thoracotomy. After propensity matching, there were 113 (62.4%) patients in the VATS group and 68 (37.6%) patients in the thoracotomy group. VATS had similar lymph node dissection ability and postoperative complication rate with thoracotomy (P>0.05), with the advantage of having shorter operative time (146.00 min vs. 165.00 min, P=0.006), less intraoperative blood loss (50.00 mL vs. 100.00 mL, P<0.001), lower intraoperative blood transfusion rate (0.0% vs. 7.4%, P=0.003), less 3-day postoperative drainage (250.00 mL vs. 350.00 mL, P=0.011; 180.00 mL vs. 250.00 mL, P=0.002; 150.00 mL vs. 235.00 mL, P<0.001), and shorter postoperative drainage time (9.34 d vs. 13.84 d, P<0.001) and postoperative hospitalization time (6.19 d vs. 7.94 d, P=0.006). Conclusion VATS after neoadjuvant therapy for NSCLC is safer than thoracotomy and results in better postoperative recovery.

Objective:To investigate the clinical features of patients with congenital atresia of the oval window (CAOW).Methods:A retrospective analysis was conducted on 7 cases (8 ears) of surgically confirmed CAOW treated at our department from July 2018 to July 2024. Among the cases, 1 patient had bilateral CAOW, and 4 patients had unilateral CAOW combined with other types of ossicular chain malformations in the contralateral ear. We collected and analyzed the clinical data, audiological features, and temporal bone HRCT results of all patients.Results:The 7 patients were diagnosed at ages ranging from 8 to 19 years, with a mean age of (13.2±6.9) years. None of the patients exhibited significant auricular deformities. All presented with conductive hearing loss or mixed hearing loss predominantly of the conductive type, with an intact tympanic membrane. The diagnosis of CAOW was confirmed via endoscopic tympanotomy, revealing a concave oval window area on the medial wall of the tympanic cavity, sealed by a bony plate. All 8 ears exhibited additional ossicular chain deformities. Stapes absence was present in all 8 ears. Partial absence of the incus long process was observed in 3 ears, while, abnormal bony connections between the incus long process and the promontory were seen in 4 ears, 1 ear had a short malleolar handle, 1 ear had a smaller than normal malleus volume. In addition, facial nerve deformities were found in 6 ears, with 4 ears showing bifurcation of the facial nerve and 2 ears showing facial nerve obscuration of the oval window. Pure-tone audiometry revealed that 62.5% (5/8 ears) of patients had air conduction (AC) thresholds≥60 dB preoperatively, with a mean pure-tone average (PTA) of (69.0±11.8) dB HL and a mean air-bone gap (ABG) of (52.0±7.0) dB. The mean AC threshold and ABG were higher in the low-frequency (125-1 000 Hz) range compared to the high-frequency (2 000-8 000 Hz) range (both P<0.05). Preoperative HRCT showed abnormalities in all patients, with 7 ears being diagnosable as CAOW. Although the remaining 1 ear could not be diagnosed as CAOW, stapes and incus long process absence were detected. Conclusion:CAOW is rare in clinical, as the patients with non-progressive conductive hearing loss (AC≥60 dB, ABG≥50 dB) since childhood, intact tympanic membrane without malformations of auricle and external auditory canal, and thick bony plate covered the oval window of the HRCT imaging, CAOW should be highly suspected, which could be confirmed by the exploratory tympanotomy.

[Objective]To investigate the effect of nicotinamide adenine dinucleotide on vascular endothelial injury in hypertension and its molecular mechanism.[Methods]C57BL/6J mice were randomly divided into saline group(Saline)and hypertension group(Ang Ⅱ,which were infused with Ang Ⅱ via subcutaneously implanted osmotic pumps),and supplemented daily with nicotinamide mononucleotide(300 mg/kg),a precursor of NAD+.Blood pressure,endothelial relaxation function and pulse wave velocity were measured after 4 weeks.Wound healing assay and adhesion assay were used to evaluate the function of endothelial cells in vitro.mtROS levels were detected by immunofluorescence staining.RT-PCR was used to detect the mRNA expression of mtDNA,SIRT3 and isocitrate dehydrogenase 2(IDH2).8-hydroxy-2'-deoxyguanosine levels were detected by enzyme-linked immunosorbent assay.The protein expression levels of p-eNOS,eNOS,SIRT3 and IDH2 were detected by Western blot.[Results]NMN supplementation reduced blood pressure(P<0.001)and improved endothelial function and arterial stiffness(P<0.001)in hypertensive mice.In vitro,NMN improved endothelial function in Ang Ⅱ-stimulated endothelial cells(P<0.05)and attenuated mitochondrial oxidative stress levels(P<0.001).Mechanistically,NMN elevated SIRT3 activity(P<0.001),which subsequently enhanced IDH activity(P<0.001)and reduced oxidative stress levels in endothelial cells.Conversely,knockdown of IDH2 would reverse the effect of SIRT3 in improving endothelial function(P<0.001).[Conclusion]NAD+lowers blood pressure and enhances vascular function in hypertension by reducing the level of oxidative stress in endothelial cells through activation of the SIRT3/IDH2 signal pathway.

Objective:To investigate the clinical features of patients with congenital atresia of the oval window (CAOW).Methods:A retrospective analysis was conducted on 7 cases (8 ears) of surgically confirmed CAOW treated at our department from July 2018 to July 2024. Among the cases, 1 patient had bilateral CAOW, and 4 patients had unilateral CAOW combined with other types of ossicular chain malformations in the contralateral ear. We collected and analyzed the clinical data, audiological features, and temporal bone HRCT results of all patients.Results:The 7 patients were diagnosed at ages ranging from 8 to 19 years, with a mean age of (13.2±6.9) years. None of the patients exhibited significant auricular deformities. All presented with conductive hearing loss or mixed hearing loss predominantly of the conductive type, with an intact tympanic membrane. The diagnosis of CAOW was confirmed via endoscopic tympanotomy, revealing a concave oval window area on the medial wall of the tympanic cavity, sealed by a bony plate. All 8 ears exhibited additional ossicular chain deformities. Stapes absence was present in all 8 ears. Partial absence of the incus long process was observed in 3 ears, while, abnormal bony connections between the incus long process and the promontory were seen in 4 ears, 1 ear had a short malleolar handle, 1 ear had a smaller than normal malleus volume. In addition, facial nerve deformities were found in 6 ears, with 4 ears showing bifurcation of the facial nerve and 2 ears showing facial nerve obscuration of the oval window. Pure-tone audiometry revealed that 62.5% (5/8 ears) of patients had air conduction (AC) thresholds≥60 dB preoperatively, with a mean pure-tone average (PTA) of (69.0±11.8) dB HL and a mean air-bone gap (ABG) of (52.0±7.0) dB. The mean AC threshold and ABG were higher in the low-frequency (125-1 000 Hz) range compared to the high-frequency (2 000-8 000 Hz) range (both P<0.05). Preoperative HRCT showed abnormalities in all patients, with 7 ears being diagnosable as CAOW. Although the remaining 1 ear could not be diagnosed as CAOW, stapes and incus long process absence were detected. Conclusion:CAOW is rare in clinical, as the patients with non-progressive conductive hearing loss (AC≥60 dB, ABG≥50 dB) since childhood, intact tympanic membrane without malformations of auricle and external auditory canal, and thick bony plate covered the oval window of the HRCT imaging, CAOW should be highly suspected, which could be confirmed by the exploratory tympanotomy.

Objective To observe the value of right ventricle modified myocardial performance index(RV-Mod-MPI)for evaluating maternal obstetric antiphospholipid syndrome(OAPS)involving fetal right ventricular function.Methods Forty-five pregnant women with maternal OAPS(OAPS group)and 60 healthy pregnant women(control group)were prospectively enrolled.Fetal RV-Mod-MPI was obtained with tricuspid and pulmonary valve flow images by applying pulsed wave Doppler(PW).Late pregnancy conditions and data of newborns after delivery were recorded.The indexes were compared between groups.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was used to assess the efficacy of fetal RV-Mod-MPI for predicting adverse pregnancy outcomes in OAPS group.Results Compared with those in control group,OAPS group had higher fetal RV-Mod-MPI values,lower newborn birth weight and lower Apgar score at 1 min after birth,as well as higher probability of adverse pregnancy outcomes(all P＜0.05).The AUC of fetal RV-Mod-MPI for predicting adverse pregnancy outcome in OAPS group was 0.726.Conclusion RV-Mod-MPI could be used to evaluate maternal OAPS involving fetal right ventricular function and predict adverse pregnancy outcomes.

Objective:To analyze the epidemiological characteristics of hospitalized patients diagnosed with sepsis in a large class Ⅲ general hospital in Southwest China in a period of 2 years, and to explore the risk factors related to death in patients with sepsis.Methods:A retrospective study was conducted to select patients with sepsis admitted to Sichuan Provincial People's Hospital from September 1, 2021 to August 31, 2023, and general characteristics such as gender, age, discharge diagnosis, discharge department, hospitalization cost, length of stay, and prognosis during hospitalization were collected. The baseline of two groups of patients were compared, and the risk factors of in-hospital cause of death in patients with sepsis were analyzed by multivariate Logistic regression.Results:A total of 3 568 patients with sepsis were included with median age of 58 (35, 74) years old. Of all patients, there were 2 147 males (60.17%). The median length of hospitalization was 13 (8, 24) days, and the median hospitalization cost was 3.98 (1.87, 8.83) ten thousand yuan. The departments with more than 100 cases of sepsis in 2 years were central intensive care unit (ICU), pediatrics department, nephrology department, emergency medicine department, emergency intensive care unit (EICU), infectious department, respiratory medicine department, hematology department, neonatal care unit and emergency surgical department. A total of 1 210 patients (33.91%) admitted to ICU (including central ICU and EICU). The hospitalization cost of ICU patients were higher [6.7 (3.1, 15.5) ten thousand yuan], the hospitalization duration was longer [9 (3, 17) days], and the mortality was higher [35.29% (427/1 210)]. Among 3 568 patients with sepsis, 448 died and 3 120 survived during hospitalization. The age, male proportion and hospitalization cost of patients with sepsis in the death group were significantly higher than those in the survival group [age (years old): 75 (60, 86) vs. 57 (30, 71), male proportion: 67.86% (304/448) vs. 59.07% (1 843/3 120), hospitalization cost (ten thousand yuan): 6.7 (3.0, 16.9) vs. 3.7 (1.8, 8.1)], the ratio of diabetes mellitus was significantly lower than that of survival group [4.91% (22/448) vs. 10.45% (326/3 120)], the length of hospitalization was shorter than that of survival group [days: 10.0 (3.0, 19.0) vs. 13.0 (8.0, 24.0)], the differences were statistically significant (all P < 0.01). Multivariate Logistic regression analysis showed that male [odds ratio ( OR) = 0.75, 95% confidence interval (95% CI) was 0.59-0.96], elder ( OR = 1.04, 95% CI was 1.03-1.05) and diabetes ( OR = 0.32, 95% CI was 0.19-0.54) were independent risk factors for in-hospital death in patients with sepsis (all P < 0.05). Conclusions:Sepsis is a heavy burden in Southwest China, especially for ICU, with high mortality, high hospitalization costs, and heavy economic burden on patients and society. Male, elder and diabetes were independent risk factors for in-hospital death of sepsis patients.

Currently, cataract surgery has entered into the refractive cataract surgery era, and accurate control of the target refractive power and the rapid and effective improvement of patient's visual quality have become the common pursuit of cataract surgeons. Application of femtosecond laser-assisted cataract surgery, surgical navigation technology, active control fluidic phacoemulsification technology, special high-quality intraocular irrigation fluid, non-drop surgery mode, ocular surface repair and dry eye management, functional intraocular lens, and postoperative visual function training can further improve the patient's diagnosis and treatment experience, accelerate patient's recovery, improve postoperative visual quality, and enhance patient's satisfaction, thus promoting the development of refractive cataract surgery.

Objective To investigate the effect of baicalein (BAI) on autophagy of gastric cancer cell line BGC-823 cells by upregulating microRNA-7-5p (miR-7) and its possible mechanism. Methods The MTT method was used to screen the optimal drug concentration of BGC-823 cells treated with BAI. Real-time quantitative PCR was used to detect the transfection efficiency of BGC-823 cell line stably transfected with miR-7. The experiment was divided into control group (mimic-NC), miR-7 group (miR-7 mimic) and BAI group ( miR-7 overexpression combined with BAI treatment group). MTT assay, plate cloning assay and EdU assay were used to detect cell proliferation. The expression levels of autophagy related 16 like 1 (ATG16L1), sequestosome 1 (p62), Beclin 1, autophagy-related protein 5 (ATG5) and microtubule-assaiated protein 1 light chain3 (LC3) were detected by immunofluorescence staining and Western blot. Network pharmacology analysis to predict possible signaling pathways; Western blot was used to detect the expression levels of phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathway. Results 50 μmol/L BAI significantly inhibited the proliferation ability of BGC-823 cells; Compared with the control group, the expression level of miR-7 was significantly increased after BAI treatment. The cell proliferation of the miR-7 group was significantly inhibited, and the protein expression level of autophagy-related proteins and the LC3II/LC3I ratio were significantly up-regulated, which promoted the formation of autophagosomes and inhibited the formation of autophagic flow in BGC-823 cells. Compared with the miR-7 group, the BAI group could further inhibit the proliferation of BGC-823 cells, induce the formation of autophagosomes, but inhibit the production of autophagy flow. Network pharmacology analysis showed that the common target genes of BAI, gastric cancer and autophagy may be related to PI3K/AKT signaling pathway. Compared with the control group, the phosphorylation levels of p-PI3K, p-AKT and p-mTOR in the miR-7 group were significantly inhibited, and the phosphorylation levels of these proteins were further inhibited in the BAI group. Conclusion BAI-mediated miR-7 inhibits the formation of autophagosomes in BGC-823 cells by inhibiting PI3K/AKT/mTOR signaling pathway, and inhibits the generation of autophagic flow.
Humans ; MicroRNAs/metabolism* ; Stomach Neoplasms/drug therapy* ; Autophagy/genetics* ; Cell Line, Tumor ; Flavanones/pharmacology* ; Cell Proliferation/genetics* ; TOR Serine-Threonine Kinases/genetics* ; Signal Transduction/drug effects* ; Proto-Oncogene Proteins c-akt/metabolism* ; Phosphatidylinositol 3-Kinases/genetics* ; Gene Expression Regulation, Neoplastic/drug effects*

Objective:To summarize the prenatal ultrasound features and prognosis of fetal goiter.Methods:The prenatal ultrasound findings and clinical data of five cases of fetal goiter in the Affiliated Hospital of Qingdao University from August 2018 to October 2022 were retrospectively analyzed regarding the sonographic features, concomitant signs, and prognosis using descriptive statistical method.Results:The five cases were first diagnosed as fetal goiter at 25-35 weeks of gestation, with all of them showing hypoechoic or medium echoic masses in the fetal anterior neck area. One case exhibited a central blood flow signal, early appearance of the distal femoral ossification center, tachycardia, increased cardiothoracic ratio during pregnancy, and developed postnatal hyperthyroidism. Three cases showed peripheral blood flow signals and had postnatal hypothyroidism, one of which had delayed appearance of distal femoral ossification center and increased cardiothoracic ratio. One case showed a peripheral blood flow signal with normal thyroid function after birth. Among the five cases, tracheal compression and polyhydramnios were found in one case; neck hyperextension was found in three cases. After treatment, the size of goiters did not change or shrunk in three cases and increased with the gestations in one case. One case did not receive any prenatal treatment and was born through cesarean section due to late detection and increased cardiothoracic ratio. Two cases underwent cesarean section at 35 gestational weeks, one had full-term cesarean section, and two delivered vaginally at term. Hyperthyroidism in one neonate was caused by excessively elevated maternal thyrotropin receptor antibody. Three cases of hypothyroidism occurred due to maternal antithyroid medication whose thyroid function recovered after supplementation of thyroxine. The thyroid function was normal in the rest of the baby. During the follow-up from 9 months to 4 years and 11 months old, no abnormalities in the intellectual and motor development of the five children were found.Conclusions:Fetal goiter often exhibits hypochoic or medium echoic mass in the anterior neck during prenatal ultrasonography. The fetal thyroid function could be evaluated according to different blood flow patterns and the presence of the ossification center. The prognosis of fetal goiter is good after active prenatal treatment.