ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

This paper summarizes clinical experience in treating acne based on the staged therapeutic principles of "eruption in warm diseases". It is considered that acne results from wind-heat retained in the lungs， invading the ying level and obstructing the blood collaterals， and is primarily a disorder involving both the wei and ying systems. In clinical practice， the treatment emphasizes the use of acrid-cool and sweet-cold methods. The core prescription is namely Yinqiaosan Qu Douchi Jia Xishengdi Danpi Daqingye Bei Xuanshen Fang （from Epidemic Warm Diseases ［《温病条辨》］）， and is adjusted according to the stage of disease. In the non-inflammatory stage， when the pathogen initially attacks the wei level， treatment focuses on acrid-cool herbs to release the exterior， with supplementary bitter-sweet ingredients such as Yejuhua （Chrysanthemum Indicum）. In the inflammatory stage， with pronounced heat toxin in the qi level affecting the ying and blood， and local stagnation of qi and blood， the approach is to clear heat and resolve toxin， using blood-cooling and stasis-resolving herbs early to prevent progression. Herbs such as Pugongying （Taraxacum Mongolicum）， Zihuadiding （Viola Yedoensis）， Tiankuizi （Semiaquilegia Adoxoides）， Chonglou （Paris Polyphylla）， Machixian （Portulaca Oleracea）， Zaojiaoci （Gleditsia Sinensis）， Chuanshanjia （Manis Pentadactyla） may be added. In the post-inflammatory erythema stage， when yin of the ying level is depleted and internal deficiency-heat arises， sweet-cold herbs are recommended to nourish the stomach and generate fluids， with the possible addition of Yiwei Decoction （益胃汤）.

OBJECTIVE: Photodynamic therapy has become an important method in clinical tumor treatment. This study aimed to investigate the effects of hematoporphyrin on multiple myeloma (MM) and its potential applications. METHODS: The MM cell line RPMI 8226 was treated with hematoporphyrin derivative (HPD), and CCK-8 assay was used to determine cell viability, apoptosis was detected by flow cytometry, intracellular reactive oxygen species (ROS) levels were measured using a detection kit combined with flow cytometry, and Western blot assay was used to detect apoptosis-related proteins and key signaling pathway protein levels. RESULTS: The optimal incubation time for the maximum absorption of HPD in RPMI 8226 cells was 4 hours. HPD significantly inhibited the proliferation of RPMI 8226 cells in a dose- and illumination time-dependent manner ( r =0.981; r =0.961). Additionally, HPD induced apoptosis in RPMI 8226 cells, but had no significant inhibitory effect on peripheral blood mononuclear cells derived from healthy individuals. HPD combined with illumination treatment significantly increased the intracellular ROS level, upregulated the expression of apoptosis-related proteins such as cleaved PARP, cleaved caspase-3 and Bax, and down-regulated the expression of proteins that maintain cell survival, such as NF-κB and Akt. CONCLUSION The HPD can inhibit the proliferation and induce apoptosis of multiple myeloma cells.
Humans ; Multiple Myeloma/pathology* ; Hematoporphyrins/pharmacology* ; Apoptosis/drug effects* ; Cell Line, Tumor ; Reactive Oxygen Species/metabolism* ; Cell Proliferation/drug effects* ; Photochemotherapy ; Cell Survival/drug effects* ; Signal Transduction

Objective:To design a device for exercise to frozen shoulder,and explore its application effect.Methods:The main body of the device for exercise to frozen shoulder adopted stainless steel,which included horizontal frame and adjustable vertical column.It is suitable to the functional rehabilitation of the shoulder in patients with frozen shoulder or postoperative joint adhesions on shoulder.Fifty patients with frozen shoulder who admitted to Zunyi Hospital of Traditional Chinese Medicine between July 2019 and December 2022 were selected.They were randomly divided into observation group(n=25)and control group(n=25)by using a random number table.Both groups received injection therapy via anterior glenohumeral joint cavity.The observation group underwent treatment using the device for exercise to frozen shoulder,while the control group received conventionally functional exercises for shoulder.The Visual Analog Scale(VAS)scores,Shoulder Pain and Disability Index(SPADI)scores,and the range of motion(ROM)of shoulder were compared between the two groups at different periods before and after treatment.Results:VAS and SPADI scores in the observation group were significantly lower than those in the control group at the 2nd week,the 2nd month,and the 6th month post-treatment(t=3.368,3.597,4.363,t=2.301,3.553,3.513,P<0.05).Flexion and abduction ROM of shoulder in the observation group were significantly higher than those in the control group at the 2nd week,the 2nd month,and the 6th month post-treatment(t=3.116,2.909,3.687,t=2.299,2.171,2.413,P<0.05).External rotation ROM of shoulder in the observation group was significantly higher than that in the control group at the 2nd month and the 6th month post-treatment(t=2.501,3.576,P<0.05).Furthermore,there were significant differences in the VAS and SPADI scores of observation group among before treatment and after 2 weeks,2 months,and 6 months of treatment(F=8.021,6.108,P<0.05).Similarly,there were significant differences in flexion,abduction and external rotation ROM of shoulder in the observation group among before treatment and after 2 weeks,2 months,and 6 months of treatment(F=8.412,10.261,4.085,P<0.05).Conclusion:The self-designed device for exercise is safe and effective in short-term adjunctive treatment to frozen shoulder,which is one kind of alternative tool that is contribute to rehabilitation of frozen shoulder.

Objective:To design a device for exercise to frozen shoulder,and explore its application effect.Methods:The main body of the device for exercise to frozen shoulder adopted stainless steel,which included horizontal frame and adjustable vertical column.It is suitable to the functional rehabilitation of the shoulder in patients with frozen shoulder or postoperative joint adhesions on shoulder.Fifty patients with frozen shoulder who admitted to Zunyi Hospital of Traditional Chinese Medicine between July 2019 and December 2022 were selected.They were randomly divided into observation group(n=25)and control group(n=25)by using a random number table.Both groups received injection therapy via anterior glenohumeral joint cavity.The observation group underwent treatment using the device for exercise to frozen shoulder,while the control group received conventionally functional exercises for shoulder.The Visual Analog Scale(VAS)scores,Shoulder Pain and Disability Index(SPADI)scores,and the range of motion(ROM)of shoulder were compared between the two groups at different periods before and after treatment.Results:VAS and SPADI scores in the observation group were significantly lower than those in the control group at the 2nd week,the 2nd month,and the 6th month post-treatment(t=3.368,3.597,4.363,t=2.301,3.553,3.513,P<0.05).Flexion and abduction ROM of shoulder in the observation group were significantly higher than those in the control group at the 2nd week,the 2nd month,and the 6th month post-treatment(t=3.116,2.909,3.687,t=2.299,2.171,2.413,P<0.05).External rotation ROM of shoulder in the observation group was significantly higher than that in the control group at the 2nd month and the 6th month post-treatment(t=2.501,3.576,P<0.05).Furthermore,there were significant differences in the VAS and SPADI scores of observation group among before treatment and after 2 weeks,2 months,and 6 months of treatment(F=8.021,6.108,P<0.05).Similarly,there were significant differences in flexion,abduction and external rotation ROM of shoulder in the observation group among before treatment and after 2 weeks,2 months,and 6 months of treatment(F=8.412,10.261,4.085,P<0.05).Conclusion:The self-designed device for exercise is safe and effective in short-term adjunctive treatment to frozen shoulder,which is one kind of alternative tool that is contribute to rehabilitation of frozen shoulder.

Non-small cell lung cancer(NSCLC)constitutes the largest portion of lung cancer overall,with high incidence and mortality rates.Apoptosis,is a hot focus in the clinical treatment of NSCLC,its main pathways include the extrinsic death receptor pathway,intrinsic mitochondrial apoptosis pathway and endoplasmic reticulum stress pathway,collectively regulating the cellular apoptosis process.Traditional Chinese medicine(TCM)has significant efficacy in the treatment and prognosis of NSCLC,with advantages such as boosting the body's resistance and less adverse drug reactions.Studies have shown that various individual Chinese herbal medicines and compound formulas can treat NSCLC through the apoptosis pathway,alleviating the adverse drug reaction of radiotherapy and chemotherapy.Based on this,this article summarizes recent domestic and international literature,focusing on apoptosis,to summarize the research progress of TCM in treating NSCLC by regulating apoptosis,aiming to provide reference for clinical treatment for NSCLC.

OBJECTIVE To explore the clinical characteristics of Tropheryma whipplei(TW)infection and observe the application of pathogenic metagenomic next-generation sequencing(mNGS)in diagnosis of TW infection.METHODS The clinical data were collected from 1 patient who was diagnosed by mNGS in the Affiliated Hospital of Jining Medical University on Apr.9,2022.The data including the results of laboratory tests and treatment out-comes were summarized,and a literature review was conducted.RESULTS A 50-year-old woman presented to the hospital with chest tightness and chest pain lasting for 3 days,accompanied by dyspnea,palpitations,and expec-toration.The chest plain CT scan and magnetic resonance imaging(MRI)scan suggested a high probability of pul-monary infection.Normal flora were isolated by culture of bronchoalveolar lavage fluid(BALF);TW and human βherpes virus type 7 were detected in BALF by mNGS,with the sequence numbers 327 000 and 9,respectively.The pulmonary symptoms of the patient were improved after joint treatment of the infection with etimicin,levo-floxacin and minocycline.The patient repeatedly sought for medical treatment due to the pain of shoulder joint and limitation of motion.CONCLUSIONS TW is one of major pathogens leading to the infections of systemic multiple systems,and it is necessary to attach great importance to the diagnosis and treatment.The traditional laboratory test method can not achieve ideal diagnosis effect and is more likely to make a missed diagnosis.mNGS is more ac-curate and more efficient than the traditional detection method in diagnosis of TW-induced diseases.Early use of mNGS can make a rapid identification of pathogens and facilitate the reasonable clinical use of antibiotics.It is of great significance for control of the disease progression,improvement of prognosis and prevention of recurrence.