Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today. Among them,the implantable collamer lens(ICL)is favored for its wide range of correction, excellent optical quality, and high safety, but the risks of postoperative complications such as glaucoma and anterior subcapsular opacification still exist. Vault is an important indicator for evaluating the safety after ICL implantation, and its ideal state is crucial for preventing complications. Studies have shown that iris morphology has a significant impact on vault. In order to further optimize surgical outcomes and improve surgical safety, this review comprehensively reviews the research progress of iris-related parameters in ICL implantation and discusses the importance of various parameters in preoperative evaluation and postoperative follow-up.

Objective To investigate the value of ¹⁸F-FDG PET/CT metabolic parameters in the prognostic assessment of nasopharyngeal cancer patients. Methods The clinical data and PET/CT metabolic parameters of 185 nasopharyngeal cancer patients were retrospectively analyzed. The collected parameters were SUV_max, MTV, TLG, total metabolic tumor volume (TMTV) and whole-body total lesion glycolysis (WTLG). The ROC curve was used to determine the optimal cut-off values of PET/CT metabolic parameters. Univariate and multivariate Cox regression models were used to screen the independent prognostic factors. Kaplan–Meier curves were used to analyze the survival differences. Results The results of univariate Cox regression analysis showed that age, pathologic type, WTLG, TMTV, MTV, and TLG were closely associated with OS and PFS; and SUV_max was associated with PFS (P<0.05). Multivariate Cox regression analysis results showed that age, TMTV, and WTLG were the independent prognostic factors for OS and PFS (P<0.05). The combination of WTLG with T/N staging (AUC=0.781 and 0.781) and TMTV with T/N staging (AUC=0.800 and 0.790) yielded greater predictive accuracy than that of WTLG and TMTV alone (AUC=0.724 and 0.719) or T/N staging (AUC=0.593 and 0.575). Conclusion TMTV and WTLG are important prognostic predictors of nasopharyngeal carcinoma. TLG and MTV of primary lesions are prognostic factors for patients’ PFS and OS. SUV_max has limited prognostic value. Systemic metabolic indexes (TMTV and WTLG), when combined with T/N staging, can optimize prognostic stratification.

Traditional Chinese medicine(TCM) capable of clearing heat and removing toxin is most commonly used in clinical practice and has the effect of removing fire-heat and toxin. Studies have shown that most of the Ilex plants have the effect of clearing heat and removing toxin, among which the varieties of I. cornuta, I. pubescens, I. rotunda, I. latifolia, and I. chinensis are most widely used. These plants generally contain triterpenoids and their glycosides, alkaloids, flavonoids, phenylpropanoids, and other chemical components, especially pentacyclic triterpenoids. According to their skeletons, pentacyclic triterpenoids can be divided into the oleanane type, the ursane type, the lupinane type, etc. Among them, ursane-type components are the most abundant, and 136 species have been found so far. These components have been proved to have pharmacological effects such as anti-inflammatory, anti-tumor, hypolipidemic, anti-thrombosis, cardiomyocyte-protective, antibacterial, and hepatoprotective effects. Therefore, this paper systematically reviews the domestic and foreign literature on Ilex plants with a focus on the research progress on pentacyclic triterpenoids and their pharmacological activities, aiming to provide reference for the development of TCM resources with the effect of clearing heat and removing toxin.
Ilex/chemistry* ; Plants, Medicinal/chemistry* ; Pentacyclic Triterpenes/pharmacology* ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/pharmacology* ; Humans ; Animals

OBJECTIVE: To analyze the serological and molecular biological characteristics of 5 patients with cis AB blood group, and to explore the safe transfusion strategy. METHODS: Serological identification of the samples' blood group was performed using anti-A, anti-B, anti-D, anti-A1, anti-H typing reagents and ABO reagent erythrocytes. Molecular biological identification of the samples' blood group was performed using PCR-SSP or gene sequencing. RESULTS: The serological identification results of blood group in 5 patients all showed inconsistent forward and reverse typing, presenting as A₂B₃ or A₂B_w. ABO gene sequencing of samples 1, 2 and 3 showed 261delG in exon 6 and 467C>T, 803G>C in exon 7. The genotypes of samples 1, 2 and 3 were determined to be cisAB/O . PCR-SSP genotyping was performed on sample 4 and 5，and the results were both cisAB/O . CONCLUSION Patients with cisAB alleles have inconsistent serological manifestations, and genetic testing is necessary to ensure the safety and effectiveness of blood transfusion.
Humans ; ABO Blood-Group System/genetics* ; Blood Transfusion ; Blood Grouping and Crossmatching ; Genotype ; Blood Group Antigens/genetics* ; Alleles ; Male ; Female

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods:A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022. Before surgery, Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch. Based on the shape and size of the wound, a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella, and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched. The skin flap was transplanted to the recipient site of the limbs, and after reasonable combination, the wound was covered. An oval hole of suitable size was cut on the side of the receiving artery. The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it, while the accompanying veins of the two were still anastomosed end-to-end. The incision was directly sutured in the donor area. Follow up and observation were conducted for the survival status, appearance, color, texture, wound healing, scar condition, and limb function of the skin flap after surgery.Results:A total of 18 patients were included, including 12 males and 6 females, age range: 41-60 years old, with an average of 48.5 years old. There were 8 cases of hands and wrists, 4 cases of forearms, 4 cases of calves, and 2 cases of feet. The wound was large and irregular, or with multiple defects, all accompanied by bone or tendon exposure, with a wound area of 5 cm × 13 cm to 17 cm × 28 cm. The area of the lobulated skin flap harvested during the operation ranged from 3 cm × 9 cm to 24 cm × 10 cm. The combined flap area was 6 cm × 14 cm to 18 cm × 30 cm. All 18 flaps survived successfully, with one case experiencing arterial crisis, which was resolved through arterial re-anastomosis. No significant contracture was observed during the 3 months to 4 years of follow-up, and the appearance of the flaps was satisfactory. The donor sites in all 18 cases healed primarily. Only linear scars remain, with no impact on limb function.Conclusion:The lobulated anterolateral thigh flap with a single perforating branch can not only effectively repair the extensive irregular or multiple defects in limbs, but also facilitate direct primary closure of the donor site and reduce donor site morbidity. Additionally, end-to-side arterial anastomosis can reduce the risk of injury to the recipient’s main vessels, lower the difficulty of vascular anastomosis, and ensure a high flap survival rate.

Objective:To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods:A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022. Before surgery, Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch. Based on the shape and size of the wound, a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella, and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched. The skin flap was transplanted to the recipient site of the limbs, and after reasonable combination, the wound was covered. An oval hole of suitable size was cut on the side of the receiving artery. The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it, while the accompanying veins of the two were still anastomosed end-to-end. The incision was directly sutured in the donor area. Follow up and observation were conducted for the survival status, appearance, color, texture, wound healing, scar condition, and limb function of the skin flap after surgery.Results:A total of 18 patients were included, including 12 males and 6 females, age range: 41-60 years old, with an average of 48.5 years old. There were 8 cases of hands and wrists, 4 cases of forearms, 4 cases of calves, and 2 cases of feet. The wound was large and irregular, or with multiple defects, all accompanied by bone or tendon exposure, with a wound area of 5 cm × 13 cm to 17 cm × 28 cm. The area of the lobulated skin flap harvested during the operation ranged from 3 cm × 9 cm to 24 cm × 10 cm. The combined flap area was 6 cm × 14 cm to 18 cm × 30 cm. All 18 flaps survived successfully, with one case experiencing arterial crisis, which was resolved through arterial re-anastomosis. No significant contracture was observed during the 3 months to 4 years of follow-up, and the appearance of the flaps was satisfactory. The donor sites in all 18 cases healed primarily. Only linear scars remain, with no impact on limb function.Conclusion:The lobulated anterolateral thigh flap with a single perforating branch can not only effectively repair the extensive irregular or multiple defects in limbs, but also facilitate direct primary closure of the donor site and reduce donor site morbidity. Additionally, end-to-side arterial anastomosis can reduce the risk of injury to the recipient’s main vessels, lower the difficulty of vascular anastomosis, and ensure a high flap survival rate.

Objective To evaluate the application effect of broth microdilution(BMD)method in susceptibility testing of multidrug-resistant Mycobacterium tuberculosis(MDR-MTB).Methods The Roche's proportion method and BMD method were adopted in drug susceptibility testing on 108 MDR-MTB strains and 11 non-MDR-MTB strains in Hainan Province.Whole genome sequencing(WGS)was performed on strains with inconsistent results by the above two methods.Results The average time to acquire drug susceptibility testing results by Roche's propor-tional method and BMD method were 28.0 and 8.5 days,respectively.Roche's proportional method showed higher resistance rates to isoniazid(INH),rifampicin(RFP),ethambutol(EMB),kanamycin(KM),and capreomycin(CPM)than BMD method(all P＜0.001).BMD method showed higher resistance rates to protionamide(PTO)and para-aminosalicylic acid(PAS)than Roche's proportional method(both P＜0.001).Taking Roche's proportional method as the gold standard,the sensitivity and specificity of BMD method for testing drug resistance were 50.00％-100％and 95.69％-100％,respectively.Except EMB(87.39％)and INH(94.96％),the consistency rates of the BMD method in testing drug resistance of other drugs were all ≥95.00％.The overall consistency rate between Roche's proportional method and WGS was 76.19％(32/42),while the consistency rate between BMD method and WGS was 23.81％(10/42),difference was statistically significant(x2=23.048,P＜0.001).34 MTB strains showed inconsistent results by two drug susceptibility testing methods.Among the 26 MTB strains that were resis-tant in Roche's proportion method but sensitive in BMD method,22 strains(84.62％)had mutations in relevant re-sistance genes.Among the 11 MTB strains that were sensitive in Roche's proportion method but resistant in BMD method,5 strains(45.45％)had mutations in relevant resistance genes.Conclusion BMD method is an accurate and rapid MDR-MTB susceptibility testing method,but further improvement and optimization are still needed.Drug resistance is closely related to mutations in relevant resistance genes.

Bipolar HF leakage current testing was carried out for two pieces of HF surgical equipment respectively by using a combination of different equipment and different connection methods according to the test method in GB 9706.202-2021 Medical electrical equipment-Part 2-2:Particular requirements for the basic safety and essential performance of high frequency surgical equipment and high frequency surgical accessories.It's pointed out relatively accurate measurements could be obtained when the HF analyzer was accessed to the circuit only as a test resistor and/or ammeter.References were provided for bipolar HF leakage current detection in HF surgical equipment.[Chinese Medical Equipment Journal,2024,45(4):88-92]