AIM: To investigate the changes of retinal nerve fiber layer(RNFL)thickness, retinal thickness and blood flow density in different stages of diabetic retinopathy(DR)patients based on optical coherence tomography angiography(OCTA).METHODS: A retrospective analysis was conducted on 382 patients(382 eyes)diagnosed with DR in our hospital from February 2023 to February 2024. According to the staging criteria, the patients were divided into mild group(n=121), moderate group(n=133), severe group(n=72), and proliferative group(n=56). The general clinical data of the four groups of patients was compared; OCTA was used to scan and collect data from all patients, and the RNFL thickness, retinal thickness, and blood flow density were compared among the four groups of patients.RESULTS: There was no statistically significant difference in age, gender, hypertension, chronic kidney disease, and random blood glucose among patients in the mild, moderate, severe, and proliferative groups(all P>0.05). As the stage of DR worsened, the duration of the disease gradually prolonged(P<0.05). The thickness of the RNFL(superior, inferior, temporal, nasal, and average thickness)and retinal thickness significantly increased with the severity of DR(all P<0.001); however, there was no statistically significant difference in inferior RNFL thickness between the moderate and mild groups(P>0.05). The blood flow density in the superficial and deep retinal layers, as well as in the choroidal capillary layer, significantly decreased with the progression of DR(all P<0.05). Nevertheless, there was no statistically significant difference in superficial retinal blood flow density between the moderate and severe groups(P>0.05).CONCLUSION: OCTA can accurately observe the changes in RNFL thickness, retinal thickness, and blood flow density in patients with DR at different stages, which can serve as sensitive indicators for monitoring DR progression.

The underlying cause of low response rates to existing immunotherapies is that tumor cells dominate tumor immune escape through surface antigen deficiency and inducing tumor immunosuppressive microenvironment (TIME). Here, we proposed an in situ tumor cell engineering strategy to disrupt tumor immune escape at the root by restoring tumor cell MHC-I/tumor-specific antigen complex (MHC-I/TSA) expression to promote T-cell recognition and by silencing tumor cell CD55 to increase the ICOSL⁺ B-cell proportion and reverse the TIME. A doxorubicin (DOX) and dual-gene plasmid (MAC pDNA, encoding both MHC-I/ASMTNMELM and CD55-shRNA) coloaded drug delivery system (LCPN@ACD) with tumor targeting and charge/size dual-conversion properties was prepared. LCPN@ACD-induced ICD promoted DC maturation and enhanced T-cell activation and infiltration. LCPN@ACD enabled effective expression of MHC-I/TSA on tumor cells, increasing the ability of tumor cell recognition and killing. LCPN@ACD downregulated tumor cell CD55 expression, increased the proportion of ICOSL⁺ B cells and CTLs, and reversed the TIME, thus greatly improving the efficacy of αPD-1 and CAR-T therapies. The application of this in situ tumor cell engineering strategy eliminated the source of tumor immune escape, providing new ideas for solving the challenges of clinical immunotherapy.

Mitochondrial DNA (mtDNA) acts as a damage-associated molecular pattern to activate the stimulator of interferon genes (STING) signaling in macrophages, promoting tissue inflammation. However, its role in acute myocardial infarction (AMI) remains unclear. Macrophage-specific Sting1 knockout mice were used to validate STING's pathological role in AMI. Cardiac and liver mtDNA were used to activate macrophages in co-culture systems with cardiomyocytes to assess fibrosis and hypertrophy. Panaxatriol saponin (PTS) was tested for its ability to block mtDNA-driven macrophage activation and subsequent cardiomyocyte damage. STING-PTS binding ability was analyzed. AMI rats received PTS to evaluate its effects on myocardial inflammation and ventricular remodeling. In vivo, macrophage-specific Sting1 knockout reduced myocardial inflammation and injury after AMI. In vitro, mtDNA-activated macrophages induced cardiomyocyte fibrosis and hypertrophy through STING signaling. PTS suppressed mtDNA-driven macrophage activation by directly binding STING, thereby blocking inflammatory cascades. In AMI rats, PTS treatment attenuated acute inflammation and reversed ventricular remodeling. These findings establish the mtDNA-STING axis in macrophages as a critical driver of post-AMI inflammation and identify pharmacological STING inhibition with PTS as a promising therapeutic strategy. The study bridges genetic validation with translational applications, highlighting macrophage STING as a novel target for ischemic heart disease management.

Objective To explore the value of preoperative detection of soluble fragments of cytokeratin-19 (CYFRA21-1), carcinoembryonic antigen (CEA), and postoperative detection of nuclear proliferation associated antigen Ki67 in prognostic evaluation of non-small cell lung cancer patients. Methods The clinicopathological data and follow-up results of patients with non-small cell lung cancer treated in the Department of Thoracic Surgery of the First Affiliated Hospital of Xiamen University in 2017 were collected. CYFRA21-1>3.39 ng/mL was defined as positive, and CEA>5 ng/mL was defined as positive. The receiver operating characteristic curve (ROC curve) of Ki67 expression level was drawn. The maximum area under the curve (AUC) was the cutoff value of Ki67 expression level, and the Ki67 expression level greater than its cutoff value was defined as positive. Cox regression analysis was used to determine the independent risk factors for poor prognosis in patients with non-small cell lung cancer. Results Finally 248 patients were collected, including 125 males and 123 females, with a median age of 61 years (ranging from 30 to 81 years) at the time of surgery. Univariate analysis showed that positive CYFRA21-1, high expression of Ki67, positive CEA, age≥60 years at operation, distant metastasis, lymph node metastasis, maximum tumor diameter>3 cm, and TNM stage Ⅲ were associated with poor prognosis in patients with non-small cell lung cancer. When combined detection of preoperative tumor markers and postoperative Ki67, the prognosis of all negative patients was the best, and that of all positive patients was the worst. Cox regression analysis showed that positive CEA+positive CYFRA21-1+high expression of Ki67 was an independent risk factor for poor prognosis in patients with non-small cell lung cancer (P<0.05). Conclusion The combined detection of preoperative serum CYFRA21-1, CEA, and postoperative Ki67 has important value in evaluating the prognosis of non-small cell lung cancer patients.

Objective To establish a predictive model for survival outcomes of glioma patients based on both brain radiomics features from preoperative MRI multi-sequence images and clinical features.Methods We retrospectively analyzed the MRI images and clinical data of 388 glioma patients and extracted the radiomics features from the peritumoral edema zone,tumor core,and whole tumor on T1,T2,and T1-weighted contrast-enhanced(T1CE)and fluid attenuated inversion recovery(FLAIR)sequences.The cases were divided into a training set(271 cases)and a test set(117 cases).Random survival forest algorithms were used to select the radiomics features associated with overall survival(OS)in the training set to construct a radiomic score(Rad-score),based on which the patients were classified into high-and low-risk groups for Kaplan-Meier survival analysis.Cox proportional hazard regression models for the 3 different tumor zones were constructed,and their performance for predicting 1-and 3-year survival rates was evaluated using 5-fold cross-validation and AUC analysis followed by external validation using data from another 10 glioma patients.The best-performing model was used for constructing a nomogram for survival predictions.Results Five radiomics features from the tumor core,7 from the peritumoral edema zone,and 5 from the whole tumor were selected.In both the training and test sets,the high-and low-risk groups had significantly different OS(P<0.05),and age,IDH status and Rad-score were independent factors affecting OS.The combined model showed better performance than the Rad-score model with AUCs for 1-year and 3-year survival prediction of 0.750 and 0.778 in the training set,0.764 and 0.800 in the test set,and 0.938 and 0.917 in external validation,respectively.Conclusion The predictive model combining preoperative multi-modal MRI radiomics features and clinical features can effectively predict survival outcomes of glioma patients.

Objective To establish a predictive model for survival outcomes of glioma patients based on both brain radiomics features from preoperative MRI multi-sequence images and clinical features.Methods We retrospectively analyzed the MRI images and clinical data of 388 glioma patients and extracted the radiomics features from the peritumoral edema zone,tumor core,and whole tumor on T1,T2,and T1-weighted contrast-enhanced(T1CE)and fluid attenuated inversion recovery(FLAIR)sequences.The cases were divided into a training set(271 cases)and a test set(117 cases).Random survival forest algorithms were used to select the radiomics features associated with overall survival(OS)in the training set to construct a radiomic score(Rad-score),based on which the patients were classified into high-and low-risk groups for Kaplan-Meier survival analysis.Cox proportional hazard regression models for the 3 different tumor zones were constructed,and their performance for predicting 1-and 3-year survival rates was evaluated using 5-fold cross-validation and AUC analysis followed by external validation using data from another 10 glioma patients.The best-performing model was used for constructing a nomogram for survival predictions.Results Five radiomics features from the tumor core,7 from the peritumoral edema zone,and 5 from the whole tumor were selected.In both the training and test sets,the high-and low-risk groups had significantly different OS(P<0.05),and age,IDH status and Rad-score were independent factors affecting OS.The combined model showed better performance than the Rad-score model with AUCs for 1-year and 3-year survival prediction of 0.750 and 0.778 in the training set,0.764 and 0.800 in the test set,and 0.938 and 0.917 in external validation,respectively.Conclusion The predictive model combining preoperative multi-modal MRI radiomics features and clinical features can effectively predict survival outcomes of glioma patients.

Objective To explore the application effect of traditional Chinese medicine rolling egg therapy in the treatment of infantile diarrhea.Methods A retrospective analysis was conducted on the clinical data of children with diarrhea in Dongguan People's Hospital from April 2022 to April 2024.According to the treatment methods,they were divided into the control group and the combination group.The control group was treated with western medicine,while the combination group was combined with traditional Chinese medicine rolling egg therapy on the basis of the control group.7 d was a course of treatment,and a total of 2 courses of treatment was conducted.The clinical efficacy was evaluated,and the durations of clinical symptom changes after treatment were compared.The intestinal flora,immune function[immunoglobulin (Ig) A,IgG,IgM]and inflammatory factors[interleukin (IL)-6,IL-17,tumor necrosis factor (TNF) α]were observed before and after treatment.The treatment safety was analyzed,and the recurrence within 6 months of follow-up was counted.Results A total of 180 patients were included in the study,with 106 in the control group and 74 in the combination group.The total effective rate of the combination group was higher than that of the control group (P<0.05).After treatment,the time to stop diarrhea,reduce fever and change stool properties to normal in the combination group was lower than that in the control group (P<0.05);the number of Bifidobacteria and Lactobacilli in both groups was higher than that before treatment,and the number of combination group was higher than that of the control group (P<0.05);the number of Enterococcus faecalis and the levels of TNF-α,IL-6 and IL-17 were lower than those before treatment in both groups,and these in the combination group were lower than those in the control group (P<0.05);the levels of IgA,IgG and IgM were higher than those before treatment in the combination group (P<0.05),and the IgA level was significantly higher than that of the control group (P<0.05).At 6 months,the recurrence rate of the combination group was lower than that of the control group (P<0.05).Conclusion Traditional Chinese medicine rolling egg therapy combined with western medicine is effective in the treatment of children with diarrhea,and its mechanism may be related to the improvement of immune function,inflammatory response and intestinal flora.

Background: Data on the efficacy and incidence of adverse effects associated with dexmedetomidine (DEX) as a local anesthetic adjuvant for patient-controlled epidural analgesia (PCEA) are inconclusive. This meta-analysis assessed the efficacy and risks of DEX for PCEA using opioids as a reference. Methods: Two researchers independently searched PubMed, Embase, Cochrane Library, and China Biology Medicine for randomized controlled trials comparing DEX and opioids as local anesthetic adjuvants in PCEA. Results: In total, 636 patients from seven studies were included in this meta-analysis. Postoperative patients who received DEX had lower visual analog scale (VAS) scores than those who received opioids at 4–8 h (mean difference [MD]: 0.61, 95% CI [0.45, 0.76], P < 0.001, I2 = 0%), 12 h (MD: 0.85, 95% CI [0.61, 1.09], P < 0.001, I2 = 0%), 24 h (MD: 0.59, 95% CI [0.06, 1.12], P = 0.030, I2 = 82%), and 48 h (MD: 0.54, 95% CI [0.05, 1.02], P = 0.030, I2 = 91%). Additionally, patients who received DEX had a lower incidence of itching (odds ratio [OR]: 2.86, 95% CI [1.18, 6.95], P = 0.020, I2 = 0%) and nausea and vomiting (OR: 6.83, 95% CI [3.63, 12.84], P < 0.001, I2 = 24%). In labor analgesia, no significant differences in neonatal (pH and PaO2 of cord blood, fetal heart rate) or maternal outcomes (duration of labor stage, mode of delivery) were found between the DEX and opioid groups. Conclusions Compared with opioids, using DEX as a local anesthetic adjuvant in PCEA improved postoperative analgesia and reduced the incidence of itching and nausea and vomiting without increasing the incidence of adverse events.

Objective:To assess the influence of a virtual simulation-based training system for composite resin filling on the knowledge acquisition, skill development, and overall learning experience of undergraduate stomatology students.Methods:Forty-one undergraduate students of grade 2019 majoring in stomatology were divided into two groups for preclinical training before their internships: the experimental group used a virtual training system for composite resin filling, while the control group watched instructional videos of the procedure. The two groups were compared for their first performance in composite resin filling during the internships and teaching feedback. The t-test and chi-square test were conducted for data analysis using SPSS 20.0. Results:After repeatedly using the virtual training system for composite resin filling, the students in the experimental group were able to master the key operational points of the procedure, all achieving high scores (an average of 91.77 points) with an average time of 10.39 minutes. During the internship phase, the experimental group and control group showed significant differences in the accuracy rates of instrument selection (85.71% vs. 40.00%), adhesive applying (76.19% vs. 45.00%), and layered filling (100.00% vs. 75.00%; all P<0.05). All the students unanimously recognized the value of the virtual simulation system and expressed their willingness to use it for preclinical training before internships. Nineteen students (90.48%) were satisfied with the learning experience with the virtual simulation training system. Conclusions:The virtual simulation training system for composite resin filling can improve students' understanding and proficiency levels of the technique before clinical internships, facilitating a smoother transition to the internship phase.

Objective:To analyze the epidemiological characteristics and spatiotemporal characteristics of human brucellosis in Henan Province.Methods:Data of human brucellosis in Henan Province from 2005 to 2021 were collected through the China Disease Prevention and Control Information System, and a descriptive epidemiological method was used to analyze the epidemic profile of brucellosis in Henan Province and the three distribution characteristics. Global and local spatial autocorrelation were used to analyze the spatial distribution and the hot spots of brucellosis in Henan Province, respectively, and spatiotemporal scanning was used to analyze the spatiotemporal clustering regions of brucellosis in Henan Province.Results:A total of 39 862 brucellosis cases were reported in Henan Province from 2005 to 2021, with an average annual incidence of 2.44/100 000, and the number of cases showed an overall increasing trend each year (χ 2trend = 11 127.85, P = 0.001). The onset months were mainly concentrated from March to July, accounting for 59.00% (23 517/39 862), with May as the peak (5 478 cases). Cases of brucellosis were reported in 157 counties (cities, districts) of the province. The ratio of male to female was 2.52∶1.00 (28 542/11 320). Farmers were the main occupation, with 32 985 cases (82.75%). The age of onset was mainly 45 to 65 years old, with 20 226 cases (50.74%). The global spatial autocorrelation analysis showed that the global Moran's I was > 0, Z > 1.96, and P < 0.05 in all years except 2006 - 2008, showing spatial clustering. Further local spatial autocorrelation analysis was performed, and high-high and low-low clustering areas existed in 2012 - 2021 ( P < 0.01). Spatiotemporal scanning analysis showed that there was one spatiotemporal cluster in the high incidence area and two spatiotemporal clusters in the low incidence area. The high incidence cluster was centered in Neixiang County, covering 48 counties (cities, districts) including Song County and Ruzhou City, and the aggregation time was from 2014 to 2021. The two low incidence clusters were centered in Yongcheng City and Boai County, covering 58 and 18 counties (cities, districts), respectively, and the aggregation time was 2016 - 2021 and 2005 - 2012, respectively. Conclusion:The overall incidence of brucellosis in Henan Province is on the rise from 2005 to 2021, with middle-aged and elderly male farmers as the main affected population, and there are spatiotemporal clusters of brucellosis in Henan Province.