OBJECTIVE To investigate the impact of Tongxinluo capsules on the pharmacokinetics of rivaroxaban in rats. METHODS Rats were randomly divided into rivaroxaban alone group （2.70 mg/kg）， low-dose Tongxinluo capsules combined with rivaroxaban group （Tongxinluo capsules 0.28 g/kg+rivaroxaban 2.70 mg/kg）， and high-dose Tongxinluo capsules combined with rivaroxaban group （Tongxinluo capsules 0.84 g/kg+rivaroxaban 2.70 mg/kg）， with five rats in each group. Following seven consecutive days of gavage with normal saline or the corresponding doses of Tongxinluo capsules， the rats were subjected to a final gavage administration of rivaroxaban. Blood samples were collected at 0 h prior to the final administration and at 0.16， 0.33， 0.50， 0.75， 1， 1.5， 2， 4， 8， 12 and 24 h post-final administration. The plasma concentration of rivaroxaban in rats was determined by high-performance liquid chromatography-tandem mass spectrometry. The pharmacokinetic parameters [peak concentration （cmax）， half-life （t1/2）， area under the drug concentration time curve （AUC）， mean residence time （MRT）， clearance （CL）， apparent volume of distribution （Vd） and peak time （tmax）] of each group were calculated using a non-compartmental model of MonolixSuite 2023R1 pharmacokinetic software. RESULTS Compared with rivaroxaban alone group， AUC₀₋ₜ and AUC0-∞ of rivaroxaban in rats were increased significantly in high-dose Tongxinluo capsules+rivaroxaban group （P＜0.05）， while CL was decreased significantly （P＜0.05）； t1/2 and MRT were shortened， tmax was extended， cmax was increased， while Vd was decreased， but there was no statistical significance （P＞0.05）. CONCLUSIONS Rivaroxaban combined with Tongxinluo capsules significantly increases the plasma exposure of rivaroxaban in rats. Potential drug-drug interactions should be considered in clinical practice based on the co-administration conditions.

In recent years,functional intraocular lenses(IOLs)have provided an effective choice for improving the visual quality of cataract patients,with high postoperative satisfaction and spectacle independence,but there are also ad-verse reactions such as glare and stereoscopic damage.More ophthalmologists have proposed the implantation of two dif-ferent IOLs to give full play to their respective advantages,thereby improving postoperative effects.It is an important topic to explore an optimized IOL implantation program for the treatment of cataracts and the correction of presbyopia.This arti-cle reviews the research progress on blended implantation of IOLs in treating cataracts and correcting presbyopia.

Objective To explore the clinical effect of a trapezoidal transparent corneal incision during phacoemulsi-fication.Methods A total of 57 patients(68 eyes)undergoing phacoemulsification were selected and divided into a con-ventional incision group and a trapezoidal incision group using a random number table method.There were 28 patients(34 eyes)in the conventional incision group,including 15 eyes(males)and 19 eyes(females),with an age range of 41-82(65.0±10.1)years;and there were 29 patients(34 eyes)in the trapezoidal incision group,including 21 eyes(males)and 13 eyes(females),with an age range of 46-87(66.0±11.1)years.All patients underwent cataract phacoemulsification combined with intraocular lens(IOL)implantation.A 3.0 mm transparent corneal incision was made for patients in the conventional incision group,while an improved trapezoidal transparent corneal incision was made for patients in the trape-zoidal incision group.The uncorrected visual acuity,intraocular pressure,corneal astigmatism,and incidence of intraoper-ative and postoperative complications were compared between the two groups.Results The uncorrected visual acuity of patients in the trapezoidal incision group was better than that of patients in the conventional incision group at 1 week and 3 months after surgery,and the differences were statistically significant(both P＜0.05).There was no statistically significant difference in intraocular pressure and corneal astigmatism between the two groups of patients at 1 week,1 month,and 3 months after surgery(all P＞0.05).The number of eyes with anterior chamber collapse and the number of eyes requiring a watertight incision in the conventional incision group were greater than those in the trapezoidal incision group during sur-gery,and the differences were statistically significant(both P＜0.05).The number of eyes with incision edema and the number of eyes with incision gap in the conventional incision group were greater than those in the trapezoidal incision group after surgery,and the differences were statistically significant(both P＜0.05).In the conventional incision group,IOL was displaced in 18 eyes due to the shallow anterior chamber and then returned to normal after the formation of the anterior chamber through a watertight incision during surgery;during the formation,iris prolapse and incarceration occurred in 2 eyes,and IOL rotation or incarceration occurred in 3 eyes.In the trapezoidal incision group,3 eyes had a shallow anterior chamber after surgery,and a watertight incision was used to form the anterior chamber;there was no IOL incarceration or displacement or iris prolapse.Conclusion The improved trapezoidal transparent corneal incision can effectively prevent IOL displacement caused by anterior chamber collapse during cataract surgery while ensuring the stability of the anterior chamber.It can also reduce the related complications caused by the watertight incision using a flushing needle and restore patients'vision as early as possible.

Objective:To investigate the application of artificial intelligence based on the neural network radiation field in repair of soft tissue defects at lower limbs.Methods:A retrospective analysis was performed of the 23 patients who had been admitted to Department of Orthopedic Surgery, Renmin Hospital of Wuhan University from June 2020 to May 2022 for soft tissue defects at lower limbs. There were 14 males and 9 females, aged (38.6±6.7) years. Causes for soft tissue defects: traffic injury in 9 cases, benign or malignant primary soft tissue tumor in 6 cases, mechanical injury in 4 cases, crush injury in 2 cases, and chronic ulcer in 2 cases. Defect locations: the thigh in 3 cases, the lower leg in 7 cases, and the ankle and distal foot in 13 cases. The areas of soft tissue defect ranged from 6.0 cm×3.8 cm to 14.7 cm×12.8 cm. The defects were repaired and reconstructed by transplantation of an anterolateral femoral free flap in 7 cases and a pedicled flap in 16 cases with the assistance of artificial intelligence based on the neural network radiation field, a cutting-edge artificial intelligence algorithm that can quickly construct and process three-dimensional model images through volume rendering under the radiation field. The flap survival rate, aesthetic satisfaction before and after treatment, time for skin flap harvesting and transplantation, functional recovery of lower limbs and incidence of complications were recorded.Results:All the 23 patients were followed up for 32(28, 36) weeks. All the flaps were harvested smoothly and survived. The time for flap harvesting and transplantation was 65.8(50.0, 76.0) min. The aesthetic satisfaction scored (2.3±0.7) points before treatment and (8.4±1.6) points 4 weeks after treatment, showing a statistically significant difference ( P<0.05). The skin flaps healed well with no complications such as hematoma or infection in all but one patient who suffered from superficial necrosis at the distal skin flap due to venous crisis but healed with a scar. On average, the functional recovery of lower limbs scored 23.7(22.0, 25.0) points at 12 weeks after operation according to the Enneking evaluation system, and the functional recovery of lower limbs was 79% (23.7/30.0). Conclusion:Application of artificial intelligence based on the neural network radiation field can achieve ideal results in repair of soft tissue defects at lower limbs, due to its advantages of rapid and accurate surgical procedures, limited damage to the donor site, and a short learning curve.

Background: Impairment and functional limitations from musculoskeletal conditions are evaluated using outcome measure tools. The Lower Extremity Functional Scale (LEFS) is one of the outcome measure tools (OMT) that assess the functional capacity of patients who have lower extremity conditions. It was originally developed in English and translated later into other languages; however, no Filipino version is available. Objective: This study aims to translate, cross-culturally adapt the LEFS into Filipino, and evaluate its psychometric properties. Methods: Using a psychometric study design, the LEFS will be translated and cross-culturally adapted into Filipino following the guidelines set by Beaton et al. and Sousa and Rojjanasrirat. These include six stages: (1) forward translation into Filipino, (2) synthesis, (3) backward translation, (4) expert committee review, (5) pilot testing/cognitive interview, and (6) psychometric testing. Filipinos with lower extremity conditions will be recruited for the pilot (n= 10) and psychometric testing (n= 200). Validity will be evaluated using face validity index, content validity index, independent t-test (knowngroup validity), and Spearman rho (concurrent validity). Reliability will be assessed using Cronbach alpha for the internal consistency and intraclass correlation coefficient for the stability. Floor and ceiling effects will also be computed. E Expected results The LEFS will be successfully translated and cross-culturally adapted into Filipino. It will be a valid and reliable outcome measure tool that physical therapists and other healthcare professionals can use for the functional assessment of patients. This study can also serve as a reference for future translation studies
Lower Extremity

Background: Based on the theory of"five Zang-organs corresponding to the seasons"in traditional Chinese medicine (TCM), physiological functions including emotions vary with the seasons. We aimed to investigate the seasonal photoperiod effects of melatonin (MT) released from the pineal gland on the MT receptor (MTR)-Gs/Gi-cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA)-cAMP response element-binding protein (CREB) signaling pathway in the hippocampus.Methods: Rats were divided into three groups: control, operation (surgery with pineal gland removal), and pseudo-operation groups (same surgery as operation group but without removing pineal gland), and fed at specific time across the four seasons. The levels of MTR, adenylate cyclase (AC), cAMP, PKA, and CREB in the hippocampus were analyzed using ELISA. The concentrations of Gs and Gi were analyzed using Western blot. The expression of CREB mRNA was detected by PCR. Results: For intragroup comparisons, compared with spring, the levels of Gs/Gi in the control group were higher in summer, autumn, and winter (P=.009 in summer;P<.001 in autumn and winter);the levels of MTR, cAMP, PKA, and CREB in the control group were significantly higher in autumn and winter than in spring (all P<.001). The levels of MTR, cAMP, PKA, and CREB in each season were significantly lower in the operation group than in the control group (all P < .05). Significant differences were noted in Gs/Gi levels between the operation group and control group in spring, autumn, and winter (all P<.05). Conclusion: Our findings suggest that MTR-Gs/Gi-cAMP-PKA-CREB signaling pathway is involved in the seasonal photoperiod effects of the pineal gland on the hippocampus and may underpin seasonal changes in emotions. It can support the prevention and treatment of the seasonal onset of mental dis-orders, and enrich the theory of"five Zang-organs corresponding to the seasons".

Objective To study the effects of hypoxia-inducible factor-1α (HIF-1α) on radiationinduced autophagic cell death in breast cancer cells.Methods MCF-7 cells were divided into four groups:control (normoxia,21％ Oxygen),irradiation (8 Gy X-rays),hypoxia (Cobalt chloride,CoCl2)and irradiation with hypoxia (CoCl2).150 μmol/L CoCl2 was utilized to induce hypoxic conditions.Western blot was applied to detect the expression of HIF-1α and MAPLC3.MDC and Hoechst staining were used to detect autophagy and apoptosis.Radiosensitivity was detected by cloning formation.The short hairpin interfering RNA (shRNA) retroviral transduction particles targeting HIF-1α was transfected into MCF-7 cells to establish HIF-1 α knockdown cells,then the radiosensibility,autophagy and apoptosis were detected.Results Compared with control group and irradiation group,the protein level of HIF-1 increased obviously in the normaxia,irradiation,hypoxia and irradiation with hypoxia groups,and the values were 0,0,1.00,1.89,respectively.The expression levels of MAPLC3 were markedly up-regulated in irradiation,hypoxia and irradiation with hypoxia groups as compared with control,and the ratios of LC3Ⅱ/LC3Ⅰ were 1.15,1.73,2.38 and 3.60,respectively.The radiosensitivity of MCF-7 cells decreased in the following order:normoxia with 3MA ＞ normoxia ＞ hypoxia with 3MA ＞ hypoxia.HIF-1α knockdown cell (pSUPER-HIF-1α Ri) and vector control were constructed.After treatment with CoCl2,survival fraction of MCF-7-pSUPER was significantly higher than that of control (t =3.080,6.946,6.658,6.380,P ＜0.05),and radiosensitivity was down-regulated after irradiation,but there was no significant difference between normoxia and hypoxia in survival fraction of MCF-7-pSUPER-HIF-1α Ri.After treatment of irradiation or hypoxia,the autophagic fractions in MCF-7-pSUPER-HIF-1α Ri significantly decreased,reduced by 21.1％,25.5％,15.5％,respectively(t =4.635,4.738,6.354,P ＜0.05) as compared with MCF-7-pSUPER,but there was no change in apoptosis.Conclusions HIF-1α may increase radiationinduced autophagy and decrease radiosensitivity,but have no influence on apoptosis.