AIM:To investigate the characteristics of corneal endothelial cells(CEC)and nuclear density(ND)in cataract patients with type 2 diabetes and to assess the impact of blood glucose related indicators.METHODS: A total of 187 cases(187 eyes)that underwent cataract surgery at our hospital from July 2023 to July 2024 were enrolled. CEC were measured using a non-contact specular microscope. ND was measured through IOLMaster 700. A total of 187 participants were further stratified based on glycosylated hemoglobin(HbA1c)and fasting blood glucose(FBG)levels. Correlation analyses and multiple linear regression analyses were used to elucidate the association between diabetic status and ocular parameters. We measured the concentrations of ascorbic acid(AA)in the aqueous humor of 52 participants.RESULTS: Compared to the control group, the diabetic group exhibited larger maximum endothelial cell size, lower endothelial cell density(ECD), a reduced proportion of hexagonal cells, higher ND, and lower corneal vertex equivalent spherical power(Scv; P<0.05). Correlation analysis revealed those changes of CEC and ND were significantly associated with the level of FBG, HbA1c, and the duration of diabetes(P<0.05). Among 52 participants, diabetic patients had lower levels of AA in their aqueous humor, indicating a diminished antioxidant ability.CONCLUSION:Diabetic state can significantly influence corneal maximum cell size, hexagonal cell ratio and ND in cataract patients, potentially linked to a decrease in total antioxidant capacity of the aqueous humor.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Non-alcoholic fatty liver disease (NAFLD), as a metabolic disease, has shown a constant upward trend in prevalence among the people in recent years. In addition to changing lifestyles and conventional drug treatment, bariatric surgery, represented by Roux-en-Y gastric bypass surgery and sleeve gastrectomy, has gradually become one of the treatment options for NAFLD. However, the mechanism of bariatric surgery in treating NAFLD remains to be studied. The "multiple-hit theory", which has gradually been recognized in recent years, believes that NAFLD is formed by the combined effect of multiple mechanisms such as insulin resistance, bile acid metabolism pathway, and intestinal flora. Based on relevant literatures and clinical practices, the authors explore the relevant mechanisms of bariatric surgery for direct or indirect treatment of NAFLD.

Single-cell RNA sequencing (scRNA-seq) is a powerful and rapidly developing emerging technology that allows complete analysis of cellular heterogeneity and provides bioinformation that is not available from holistic analysis compared to traditional bulk RNA sequencing (bulk RNA-seq).In recent years, the technique has been widely used in the characterization and detection of single cells and the study of biological mechanisms at the cellular level.Currently, the application of scRNA-seq in the field of ophthalmology has been reported.Gene expression at the single cell level has been studied in animal models, retinal organoids, primary human retina, retinal pigment epithelium (RPE), and choroidal visual systems.Similarly, scRNA-seq research has identified many ocular diseases under the background of the change of gene expression patterns, including how choroid blood vessel endothelial cell changes in age-related macular degeneration (AMD), the degradation of the function of cells in the retina of diabetic mice subtypes and myopic sclera fiber layer in the organization of various types of heterogeneous cells in mice, and so on.In addition, the scRNA-seq has identified the molecular, cellular and physiological characteristics of several eye tumors, including the cell origin and target molecules of retinoblastoma, the heterogeneity of uveal melanoma, and new therapeutic targets.This article mainly introduces the latest application of scRNA-seq technology in ophthalmology-related diseases to provide a reference for researchers, hoping that the technology can be extended to more related research in ophthalmology.

Objective: To explore the associations of family structure with adolescent mental health and health associated behaviors, to support interventions to decrease the occurrence of psychological problems and adverse health associated behaviors among adolescents in families without two parents. Methods: The multi stage stratified random cluster sampling method was used to select 18 700 adolescents of the 13 districts and cities from Jiangsu Province for a questionnaire survey on mental health and health associated behaviors, to compare differences in mental health and health associated behaviors among adolescents with different family structures. Results: Among the adolescents, 82.1% had two parent families, 8.6% had single mother families, 4.0% had single father families, and 5.3 % had families with both parents absent. After controlling for age, urban/rural areas, gender, academic period and region, Logistic multivariate regression analysis showed that compared with adolescents from two parent families, the incidence of depression, social anxiety and bullying on campus of adolescents with single mother families increased significantly( OR=1.31, 1.15, 1.36，P ＜0.05). Compared with adolescents in two parent families, adolescents in families without two parents had significantly more types of health risk behaviors, and those in single mother families had significantly less frequent intake of a healthful diet( OR =0.81), significantly more smoking( OR =1.20), drinking behaviors( OR =1.22), and significantly less moderate intensity physical activity ( OR =0.84) and shorter duration of sleep( OR =0.87)( P <0.05). Conclusion Psychological and health associated problems were significantly higher among adolescents in families without two parents than in those with two parent families. Psychological problems and adverse health associated behaviors were particularly prominent among adolescents in single mother families.

Objective: To investigate the incidence of juvenile myopia and associated factors in Nantong, to analyze the relationship between food intake and juvenile myopia, so as to provide a reference for preventing and controlling myopia of adolescents. Methods: Stratified cluster random sampling was used to select 13 schools in Nantong. A total of 3 437 students were selected for health monitoring and questionnaire survey, and the students sociodemographic characteristics and diet related information were collected. Results: The prevalence of myopia was 73.4%( n =2 522). The myopia rate of urban teenagers(74.1%) was higher than that in suburbs(72.4%), and the myopia rate of urban girls (78.2%)was higher than that of suburban girls(73.6%). Multivariate Logistic regression analysis showed that there was a significant positive correlation between the frequency of high energy food intake and myopia among urban adolescents ( OR =1.50, P <0.01). After adjusting for covariates, e.g. age, parental myopia, participation in extracurricular classes, outdoor inter class activities, the frequency of high energy food intake was significantly positively associated with myopia ( OR =1.29, P =0.03). Frequency of high energy food intake was significantly positively correlated with myopia of suburban adolescents ( OR =1.35, P =0.02). The association disappeared after adjusting for above ment ioned covariates ( P = 0.60 ). Conclusion There are differences in the main risk factors affecting the incidence of myopia between urban and suburban adolescents in Nantong. Parents, schools and the society should pay attention to adolescent myopia and high energy diet mode, pay attention to guide their reasonable eating habits, and prevent and control adolescent myopia from multiple angles.

Objective:To observe the clinical features of cytomegalovirus (CMV) retinitis (CMVR)- related uveitis after hematopoietic stem cell transplantation (HSCT).Methods:A retrospective clinical study. From October 2015 to May 2020, 14 cases of 21 eyes of CMVR patients with CMVR after HSCT confirmed by the ophthalmological examination of The First Affiliated Hospital of Soochow University were included in the study. Among them, there were 5 males with 8 eyes and 9 females with 13 eyes. The average age was 35.12± 12.24 years old. All the affected eyes were examined by slit lamp microscope combined with front lens and fundus color photography. At the same time, fluorescein fundus angiography (FFA) was performed to examine 10 eyes of 5 cases; 3 cases of 3 eyes were examined for inflammatory cytokines in aqueous humor. All eyes received intravitreal injection of ganciclovir; patients with a history of systemic CMV infection received intravenous infusion of ganciclovir/foscarnet. The retinal lesions in the eye were completely resolved or the aqueous CMV-DNA was negative as a cure for CMVR. The uveitis symptoms, signs, FFA manifestations and the test results of inflammatory factors in aqueous humor before and after the CMVR cure was observed. The follow-up time after CMVR was cured was 3-42 months, and the average follow-up time was 14.28±13.12 months.Results:All eyes with CMVR were diagnosed with retrocorneal dust and/or stellate keratic precipitates (KP), anterior chamber flare and cells, and varying degrees of vitreous flocculent opacity; the retina was typical of a mixture of hemorrhage and yellow-white necrosis like "scrambled eggs with tomatoes". After CMVR was cured, there were 16 eyes (71.4%, 10/14) in 10 cases with KP, anterior chamber flare, cell and vitreous opacity. FFA examination revealed that the majority of retinal leakage during the active period of CMVR was necrotic foci and surrounding tissues; after CMVR was cured, the majority of retinal leakage was the retina and blood vessels in the non-necrotic area. The test results of inflammatory factors in aqueous humor showed that interleukin (IL)-6, IL-8, and vascular endothelial cell adhesion molecules were significantly increased in the active phase of CMVR; after 3 months of CMVR cured, inflammatory factors did not increase significantly.Conclusion:CMVR-associated uveitis after HSCT show as chronic panuveitis, with no obvious eye congestion, KP, anterior chamber flare, cell and vitreous opacity, and retinal vessel leakage which could exist for a long time (>3 months).

Objective To investigate the expression of peripheral programmed death (PD)-1hiCXCR5-CD4+T cells and its clinical significance in systemic lupus erythematosus (SLE). Methods Peripheral blood PD-1hiCXCR5-CD4+ T cells from 21 SLE patients and 16 healthy controls were examined by flow cytometry. The levels of serum anti-double-stranded deoxyribonucleic acid (dsDNA) antibodies were determined using immunoradiometric as-say. Data were analyzed with t test and Pearson's correlation test. Results The per-centages of PD-1hiCXCR5- cells within CD4+ T cell were significantly higher in SLE patients [(2.1 ±2.0)％] compared to normal controls [(0.3±0.3)％] (t=2.959, P<0.01). The percentages of PD-1hiCXCR5-cells within CD4+T cells in moderate to severe active SLE patients (3.0 ±2.0)％ was significantly increased compared to patients with mild or inactive (1.0±1.4)％(t=2.574, P<0.05) and normal controls (0.3±0.3)％ (t=5.149, P<0.01). The percentages of PD-1hiCXCR5- cells within CD4+ T cells from SLE patients were positively related with systemic lupus erythematosus disease activity index (SLEDAI) (r=0.475, P=0.0297). SLE patients in serum anti-dsDNA antibodies positive group (2.7±2.1)％displayed a higher percentage of PD-1hiCXCR5-cells within CD4+T cells than patients in serum anti-dsDNA antibodies negative group (0.6 ±0.5)％ (t=2.303, P<0.05). The percentages of PD-1hiCXCR5-cells within CD4+T cells from SLE patients were positively correlated with anti-dsDNA antibody titers. Conclusion The percentages of PD-1hiCXCR5- cells within CD4+ T cells from SLE patients are increased and are positively correlated with SLEDAI and anti-dsDNA antibody levels. Increased percentage of PD-1hiCXCR5-cells within CD4+T cells might play an important role in the pathogenesis of SLE.

Objective To observe the clinical characteristics and treatment of cytomegalovirus retinitis (CMVR) in leukemia patients.Methods This is a retrospective analysis. Seven leukemia patients (13 eyes) with CMVR were studied. All patients underwent examinations of visual acuity, slit lamp microscope, ophthalmoscope, color fundus photography, peripheral blood CD4+T cell count and serum/aqueous CMV-DNA test. All patients were treated with ganciclovir or zoledronic acid combined with intravitreal injection of ganciclovir. The follow-up period was 3-14 months.Results Six patients were treated with hematopoietic stem cell transplantation and 1 patient was with chronic leukemia. All patients were CMV-DNA positive for serum, and 18.5％ (2/7) for aqueous humor. CMVR in leukemia patients showed mild anterior segment inflammation, ocular fundus with irregular yellowish-white retinal necrosis and radial hemorrhage (7 eyes). Some (2 eyes) also shoed gray and white granular retinal infiltrates. Intravenous ganciclovir/zoledronic acid combined with intravitreal injection of high concentration ganciclovir was an effective treatment, while systemic corticosteroids were effective in reducing vitreous opacity.Conclusions CMVR is characterized by progressive necrotic retinitis with hemorrhage and vasculitis. Intravenous ganciclovir/zoledronic acid combined with intravitreal injection of ganciclovir is effective in the treatment of CMVR with leukemia.