Objective:To compare the efficacy of pars plana vitrectomy (PPV) combined with subretinal or intravitreal injection of Conbercept for the treatment of refractory diabetic macular edema (DME).Methods:A retrospective case control study. From June 2022 to March 2024, 32 eyes of 32 patients with refractory DME diagnosed at The Affiliated Eye Hospital of Nanchang University were included in the study. There were 17 male cases with 17 eyes and 15 female cases with 15 eyes. Age was (57.44±8.99) years old; The duration of diabetes was (12.72±6.11) years. All patients had received regular treatment with anti-vascular endothelial growth factor (VEGF) drugs or corticosteroid drugs for at least 5 times, and had undergone focal retinal laser photocoagulation or panretinal laser photocoagulation, the central macular thickness (CMT) persisted or decreased by less than 50 μm. All affected eyes underwent best-corrected visual acuity (BCVA), intraocular pressure, optical coherence tomography (OCT), microperimetry, and laboratory glycated hemoglobin (HbA1c) testing. BCVA was measured using a standard logarithmic visual acuity chart, and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. CMT was measured using an OCT device. Microperimetry was performed using an MP-3 microperimeter, recording the mean sensitivity (MS) of the retina within a 12° range of the fovea. The affected eyes were treated with 23G PPV combined with internal limiting membrane peeling and either macular subretinal or intravitreal injection of Conbercept, and were divided into subretinal injection group and the intravitreal injection group, each consisting of 16 cases and 16 eyes. The same equipment and methods as before surgery were used for related examinations at 1, 3, and 6 months post-surgery. Changes in BCVA, CMT, and MS were observed and compared, as well as the number of additional anti-VEGF treatments required within 6 months after surgery. Intergroup comparisons were made using independent samples t tests, and repeated measures data were analyzed using repeated measures analysis of variance. Results:The age ( t=-0.271), gender composition ( χ2=0.001), duration of diabetes ( Z=-0.868), HbA1c ( t=-0.789), intraocular pressure ( t=1.689), logMAR BCVA ( t=1.393), CMT ( t=-0.613), MS ( Z=-0.132), and the number of anti-VEGF injections ( t=-0.752) between the subretinal injection group and the intravitreal injection group showed no statistically significant differences ( P>0.05). The within-subject effects comparison of BCVA, CMT, and MS at 1, 3, and 6 months post-surgery compared to pre-surgery for all affected eyes showed statistically significant differences ( F=8.060, 125.722, 39.054; P<0.05). The overall comparison of logMAR BCVA between the subretinal and intravitreal injection groups post-surgery showed no statistically significant difference ( F=0.662, P=0.422), however, comparisons of CMT ( F=4.540) and MS ( F=6.066) showed statistically significant differences ( P<0.05). At 1, 3, and 6 months post-surgery, comparisons of logMAR BCVA between the two groups showed no statistically significant differences ( t=-0.123, 0.239, 1.087; P>0.05), comparisons of CMT showed statistically significant differences ( t=-3.474, -4.832, -2.482; P<0.05), comparisons of MS showed statistically significant differences at 1 and 3 months ( t=-2.940, -2.545; P<0.05), but not at 6 months ( t=-1.527, P>0.05). At 6 months post-surgery, the number of additional intravitreal anti-VEGF injections required in the subretinal and intravitreal injection groups showed a statistically significant difference ( Z=-2.033, P=0.042). During the follow-up period and at the final follow-up, no complications such as injection site bleeding, retinal detachment, vitreous hemorrhage, macular hole, or retinal pigment epithelial tear or atrophy occurred in all affected eyes. Conclusion:Compared with intravitreal injection, subretinal injection of Conbercept for the treatment of refractory DME has more advantages in reducing macular edema and improving visual function in the macular area, and also reduces the number of postoperative anti-VEGF drug treatments.

Objective To evaluate the clinical efficacy of tendon-regulating and bone-setting manipulation combined with subtalar joint arthroereisis in the treatment of adolescent flexible flatfoot.Methods A retrospective analysis was conducted on the clinical data of 86 children with flexible flatfoot treated at Dongguan Hospital of Guangzhou University of Chinese Medicine(Dongguan Traditional Chinese Medicine Hospital)between December 2022 and February 2024.Based on pre-treatment physician-patient communication,the children were divided into an trial group(44 cases)and a control group(42 cases).The control group received subtalar joint arthroereisis alone,while the trial group received additional tendon-regulating and bone-setting manipulation just once one day before surgery and once weekly postoperatively for one month,with a follow-up period of no less than 6 months.The Visual Analogue Scale(VAS)pain score,American Orthopaedic Foot & Ankle Society(AOFAS)ankle-hindfoot score,Tegner activity score,radiographic parameters,and static plantar pressure parameters of the two groups were observed before and after surgery.Results(1)Regarding clinical data,all surgeries were successfully completed in both groups.There were no statistically significant differences in perioperative general data,including operative time,hospital stays,and complication rates(P＞0.05).All children were followed up for no less than 6 months.The results showed that at the final follow-up,the VAS pain score,AOFAS ankle-hindfoot score,and Tegner activity score were significantly improved in both groups compared to preoperative values(P＜0.05),and the improvement in the trial group was significantly greater than that in the control group(P＜0.05 or P＜0.01).(2)Regarding radiographic parameters,at the final follow-up,the talonavicular coverage angle(TNCA),talus-first metatarsal angle(T1MT),talus-second metatarsal angle(T2MT)on weight-bearing anteroposterior radiographs,and the Meary angle between the talus and the first metatarsal as well as calcaneal Pitch angle(Pitch angle)on weight-bearing lateral radiographs were significantly improved in both groups compared to preoperative values(P＜0.05).The improvement in Meary angle,T1MT angle,and T2MT angle in the trial group was significantly greater than that in the control group(P＜0.01).However,there were no statistically significant differences in TNCA and Pitch angle between the two groups at the final follow-up(P＞0.05).(3)Regarding plantar pressure testing,at the 1-month postoperative follow-up,the forefoot load increased significantly in both groups compared to preoperative values(P＜0.05),while the midfoot load significantly decreased(P＜0.05).The increase in forefoot load and decrease in midfoot load in the trial group were significantly greater than those in the control group(P＜0.05 or P＜0.01).However,there were no statistically significant differences in hindfoot load between preoperative and postoperative values or between the two groups at the 1-month follow-up(P＞0.05).Conclusion For adolescent flexible flatfoot,tendon-regulating and bone-setting manipulation combined with subtalar joint arthroereisis can effectively restore the arch,improve foot mechanical imbalance,thereby correcting flatfoot deformity and enhancing joint motor function.

Objective:To compare the efficacy of pars plana vitrectomy (PPV) combined with subretinal or intravitreal injection of Conbercept for the treatment of refractory diabetic macular edema (DME).Methods:A retrospective case control study. From June 2022 to March 2024, 32 eyes of 32 patients with refractory DME diagnosed at The Affiliated Eye Hospital of Nanchang University were included in the study. There were 17 male cases with 17 eyes and 15 female cases with 15 eyes. Age was (57.44±8.99) years old; The duration of diabetes was (12.72±6.11) years. All patients had received regular treatment with anti-vascular endothelial growth factor (VEGF) drugs or corticosteroid drugs for at least 5 times, and had undergone focal retinal laser photocoagulation or panretinal laser photocoagulation, the central macular thickness (CMT) persisted or decreased by less than 50 μm. All affected eyes underwent best-corrected visual acuity (BCVA), intraocular pressure, optical coherence tomography (OCT), microperimetry, and laboratory glycated hemoglobin (HbA1c) testing. BCVA was measured using a standard logarithmic visual acuity chart, and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. CMT was measured using an OCT device. Microperimetry was performed using an MP-3 microperimeter, recording the mean sensitivity (MS) of the retina within a 12° range of the fovea. The affected eyes were treated with 23G PPV combined with internal limiting membrane peeling and either macular subretinal or intravitreal injection of Conbercept, and were divided into subretinal injection group and the intravitreal injection group, each consisting of 16 cases and 16 eyes. The same equipment and methods as before surgery were used for related examinations at 1, 3, and 6 months post-surgery. Changes in BCVA, CMT, and MS were observed and compared, as well as the number of additional anti-VEGF treatments required within 6 months after surgery. Intergroup comparisons were made using independent samples t tests, and repeated measures data were analyzed using repeated measures analysis of variance. Results:The age ( t=-0.271), gender composition ( χ2=0.001), duration of diabetes ( Z=-0.868), HbA1c ( t=-0.789), intraocular pressure ( t=1.689), logMAR BCVA ( t=1.393), CMT ( t=-0.613), MS ( Z=-0.132), and the number of anti-VEGF injections ( t=-0.752) between the subretinal injection group and the intravitreal injection group showed no statistically significant differences ( P>0.05). The within-subject effects comparison of BCVA, CMT, and MS at 1, 3, and 6 months post-surgery compared to pre-surgery for all affected eyes showed statistically significant differences ( F=8.060, 125.722, 39.054; P<0.05). The overall comparison of logMAR BCVA between the subretinal and intravitreal injection groups post-surgery showed no statistically significant difference ( F=0.662, P=0.422), however, comparisons of CMT ( F=4.540) and MS ( F=6.066) showed statistically significant differences ( P<0.05). At 1, 3, and 6 months post-surgery, comparisons of logMAR BCVA between the two groups showed no statistically significant differences ( t=-0.123, 0.239, 1.087; P>0.05), comparisons of CMT showed statistically significant differences ( t=-3.474, -4.832, -2.482; P<0.05), comparisons of MS showed statistically significant differences at 1 and 3 months ( t=-2.940, -2.545; P<0.05), but not at 6 months ( t=-1.527, P>0.05). At 6 months post-surgery, the number of additional intravitreal anti-VEGF injections required in the subretinal and intravitreal injection groups showed a statistically significant difference ( Z=-2.033, P=0.042). During the follow-up period and at the final follow-up, no complications such as injection site bleeding, retinal detachment, vitreous hemorrhage, macular hole, or retinal pigment epithelial tear or atrophy occurred in all affected eyes. Conclusion:Compared with intravitreal injection, subretinal injection of Conbercept for the treatment of refractory DME has more advantages in reducing macular edema and improving visual function in the macular area, and also reduces the number of postoperative anti-VEGF drug treatments.

Objective To explore the efficacy and safety of pars plan vitrectomy(PPV)combined with internal limit-ing membrane(ILM)covering surgery in patients with large-diameter idiopathic macular holes(IMH)using optical coher-ence tomography angiography(OCTA)and microperimetry.Methods Twenty-three eyes of 23 patients with large-diame-ter IMH treated at the Eye Hospital Affiliated with Nanchang University from February 2023 to July 2023 were selected.The patients'best-corrected visual acuity(BCVA),hole closure rate,microcirculation[perfusion density at the superficial cap-illary plexus(PSCP)and vascular density at the retinal superficial capillary plexus(VSCP)]in the macular area(divided into central,inner and outer regions),macular sensitivity(MS),fixation stability,and foveal avascular zone(FAZ)area were observed before surgery and at 1 week,1 month,3 months,and 6 months after surgery.Changes in eye parameters before and after surgery were compared,and the correlation between parameters was analyzed.Results After a 6-month follow-up,all macular holes in the affected eyes were closed,with a closure rate of 100％.Compared to before surgery,the BCVA of the patients improved gradually at 1 week,1 month,3 months,and 6 months after surgery,and the differ-ences between any two time points were statistically significant(all P＜0.05).The FAZ area decreased at 1 week,1 month,3 months,and 6 months after surgery compared to before surgery,and the differences were statistically significant(all P＜0.05).The VSCP in the three regions showed a decrease at 1 week postoperatively and an increase at 6 months postoperatively compared to before surgery,and the differences were statistically significant(both P＜0.05).The PSCP in-creased at 3 months and 6 months postoperatively compared to before surgery,with statistically significant differences(both P＜0.05).The 12° MS increased at 1 month,3 months,and 6 months after surgery compared to before surgery,with statistically significant differences(all P＜0.05).The proportions of fixation points within 2° and 4° increased at 1 month,3 months,and 6 months postoperatively compared to before surgery,with statistically significant differences(all P＜0.05).The proportion of fixation points within 4° increased at 1 week postoperatively compared to before surgery,with a statistically significant difference(P＜0.05).Correlation analysis showed that preoperative MS and the proportion of fixa-tion points within 2° were negatively correlated with BCVA(logMAR)at 6 months postoperatively(r=-0.819,-0.790,both P＜0.05),while preoperative FAZ area and minimum hole diameter were positively correlated with BCVA(logMAR)at 6 months postoperatively(r=0.596,0.853,both P＜0.05).The preoperative VSCP in the inner and outer regions were negatively correlated with BCVA(logMAR)at 6 months postoperatively(r=-0.521,-0.570,both P＜0.05).Conclu-sion The results of OCTA and microperimetry show that after treatment with PPV and ILM covering surgery,the closure rate of large-diameter IMH is good,and all indicators have improved compared to before surgery.

Objectives:The purpose of this study is to evaluate the impact of the cumulative workload of HUTT testing physicians on diagnostic outcomes. Methods:This study retrospectively and consecutively included the data of testing physicians and patients who underwent HUTT at Fuwai Hospital,Chinese Academy of Medical Sciences,from January 2016 to December 2022.Based on the cumulative workload of physicians during the period from the initiation of tilt tests at the hospital to the end of the study,the physicians were categorized into low (50-100 sases),moderate (100-350 sases),and high (1000-4000 sases) cumulative workload groups,the cumulatie workload of no physician is 351-999 sases.Additionally,physicians were grouped by sex,educational background,and professional title to analyze differences in diagnostic rates of tilt table test reports within and between these groups. Results:The study included 22 testing physicians and 6122 patients.There were statistically significant differences in the rates of positive,suspicious positive,and negative reports among the 22 physicians (P<0.001).The average suspicious positive report rate in the moderate cumulative workload group was significantly higher than in the low and high cumulative workload groups (3.21％ vs.1.09％ vs.1.62％,P=0.001).The suspicious positive report rate was higher in the female physician group compared to the male physician group (2.25％ vs.1.07％,P=0.017),in the undergraduate physician group compared to the postgraduate physician group (2.46％ vs.1.52％,P=0.013),and in the junior title group compared to the intermediate and senior title groups (3.40％ vs.1.75％ vs.2.53％,P=0.024).Multivariate logistic regression analysis showed that a moderate cumulative workload was an influencing factor for suspicious positive reports,regardless of whether negative or positive was used as the reference (all P<0.05). Conclusions:There are certain differences in the diagnostic report rates of HUTT among different individual physicians.Physicians with a moderate cumulative workload are more likely to issue suspicious positive HUTT diagnostic reports.

Objective:To observe the effectiveness and safety of pars plana vitrectomy (PPV) combined with inner limiting membrane (ILM) removal and 41G microneedle subretinal injection of balanced salt solution (BSS) in the treatment of refractory macular hole.Methods:A prospective clinical study. From January to June 2023, 20 cases (20 eyes) of refractory macular hole patients diagnosed through examination at The Affiliated Eye Hospital of Nanchang University were included in the study. The basal diameter of the affected eye's basal diameter (BD) was >1 000 μm. Macular hole index (MHI) was <0.5. The affected eye received treatment with 23G PPV combined with ILM removal and 41G microneedle subretinal injection of BSS. Best corrected visual acuity (BCVA), microperimetry, and optical coherence tomography angiography (OCTA) were performed before and 1, 2, 3, and 6 months after surgery for the affected eye. BCVA examination was performed using standard logarithmic visual acuity chart, and convert it to logarithmic minimum resolution angle (logMAR) visual acuity for statistical purposes. MP-3 microperimetry was used for micro view examination, record the mean sensitivity (MS) of the retinal within a 12° range of the fovea. OCTA was used to measure the area of the avascular zone of the macula (FAZ), perimeter of the FAZ (PERIM), retinal vascular length density (VLD), and vascular perfusion density (VPD). The changes in BCVA, MS, FAZ area, PERIM, VLD, VPD before and after surgery were compared and analyzed. After the same time, the closure of macular hole and the occurrence of complications after surgery were observed. Single factor analysis of variance was used to compare the observation indicators at different times before and after surgery. The correlation between various observation indicators and preoperative minimum diameter (MD), BD, and hiatus height at 6 months after surgery were analyzed using Pearson correlation analysis.Results:Among the 20 cases with 20 eyes, there were 2 males with 2 eyes and 18 females with 18 eyes. Age was (61.45±8.56) years old. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD of the affected eye were 1.46±0.21, (16.20±5.81) dB、(0.40±0.17) mm 2, (2.89±0.99) mm, (6.23±3.59) mm -1, (0.17±0.10)%, respectively. Six months after surgery, out of 20 eyes, macular hole closure and incomplete closure were 18 (90.0%, 18/20) and 2 (10.0%, 2/20) eyes, respectively. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD were 0.80±0.20, (22.20±4.60) dB, (0.18±0.10) mm 2, (1.83±0.80) mm, (9.54±2.88) mm -1, (0.31±0.14)%. Compared with before surgery, the differences were statistically significant ( P<0.05). The correlation analysis results showed a positive correlation ( P<0.05) between preoperative BD and postoperative 6-month PERIM and VPD. There was a negative correlation between preoperative MD and postoperative VLD at 6 months ( P<0.05). There was a negative correlation between preoperative MHI and logMAR BCVA and VPD at 6 months after surgery ( P<0.05). No complications such as elevated or decreased intraocular pressure, damage to retinal pigment epithelium, retinal hemorrhage, endophthalmitis, or retinal detachment occurred after surgery in all affected eyes. Conclusion:Minimally invasive PPV combined with ILM removal and 41G microneedle subretinal injection of BSS can effectively improve the closure rate of refractory macular hole patients in the short term, improve vision, and have good safety.

Background: Chronic exposure to elevated levels of saturated fatty acids results in pancreatic β-cell senescence. However, targets and effective agents for preventing stearic acid-induced β-cell senescence are still lacking. Although melatonin administration can protect β-cells against lipotoxicity through anti-senescence processes, the precise underlying mechanisms still need to be explored. Therefore, we investigated the anti-senescence effect of melatonin on stearic acid-treated mouse β-cells and elucidated the possible role of microRNAs in this process. Methods: β-Cell senescence was identified by measuring the expression of senescence-related genes and senescence-associated β-galactosidase staining. Gain- and loss-of-function approaches were used to investigate the involvement of microRNAs in stearic acid-evoked β-cell senescence and dysfunction. Bioinformatics analyses and luciferase reporter activity assays were applied to predict the direct targets of microRNAs. Results: Long-term exposure to a high concentration of stearic acid-induced senescence and upregulated miR-146a-5p and miR- 8114 expression in both mouse islets and β-TC6 cell lines. Melatonin effectively suppressed this process and reduced the levels of these two miRNAs. A remarkable reversibility of stearic acid-induced β-cell senescence and dysfunction was observed after silencing miR-146a-5p and miR-8114. Moreover, V-maf musculoaponeurotic fibrosarcoma oncogene homolog A (Mafa) was verified as a direct target of miR-146a-5p and miR-8114. Melatonin also significantly ameliorated senescence and dysfunction in miR-146a-5pand miR-8114-transfected β-cells. Conclusion These data demonstrate that melatonin protects against stearic acid-induced β-cell senescence by inhibiting miR-146a- 5p and miR-8114 and upregulating Mafa expression. This not only provides novel targets for preventing stearic acid-induced β-cell dysfunction, but also points to melatonin as a promising drug to combat type 2 diabetes progression.

Background::Abnormal lipids are strong predictors of cardiovascular disease in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). However, the potential associations of insulin resistance (IR) and beta-cell function (BCF) with abnormal lipids in newly diagnosed T1DM or T2DM patients are not fully understood.Methods::A cross-sectional survey of 15,928 participants was conducted. Homeostasis model assessment and postprandial C-peptide levels were used to estimate IR and BCF. A restricted cubic spline (RCS) nested in binary logistic regression was used to examine the associations of IR and BCF with abnormal lipids.Results::High triglyceride (TG), low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol (LDL-C) accounted for 49.7%, 47.8%, and 59.2% of the participants, respectively. In multivariable analysis, high IR was associated with an increased risk of high TGs ( P for trend <0.001) in T1DM and is associated with an elevated risk of high TG and low HDL-C (all P for trend <0.01) in T2DM. Low BCF was not associated with risks of dyslipidemia in patients with T1DM or T2DM after adjustment for potential confounders. Conclusion::High IR had different associations with the risk of dyslipidemia in newly diagnosed T1DM and T2DM patients, suggesting that early treatment that improves IR may benefit abnormal lipid metabolism.

OBJECTIVE： To study the effects of 60Co-γ radiation on the botanical traits and property of Andrographis paniculata， and to screen suitable irradiation dose. METHODS： The seeds of A. paniculata were irradiated by 60Co-γ rays with different irradiation doses（0，10，20，50，100，200，300 Gy）. The botanical traits indexes of A. paniculata as seed germination rate， root length， seedling rate， seedling height， leaf area， fresh weight， dry weight， stomata number of lower epidermis of leaf， and its property indexes as the contents of andrographolide， dehydrated andrographolide and chlorophyll， activity of T-SOD enzyme and CuZn-SOD enzyme， were determined after radiation. The coefficient of variation （CV） was calculated. The linear regression analysis was performed for seedling rate， and medial lethal dose was calculated. The correlation analysis was performed between the parameters of botanical trait and quality property with irradiation dose. Cluster analysis was conducted for M1 generation of A. paniculata in different irradiation dose groups by connection method combined with squared euclidean distance. RESULTS： Different irradiation doses showed different effects on botanical traits and property of A. paniculata. According to the average value of CV， the index of botanical traits was ranked as leaf area ＞ fresh weight ＞ dry weight ＞ plant height ＞ root length ＞ stomata number ＞ seedling rate ＞ germination rate； among different irradiation dose groups， the coefficient of variation was ranked as 50 Gy＞200 Gy＞100 Gy＞20 Gy＞10 Gy＞300 Gy＞0 Gy. According to the average value of CV， the index of property was ranked as dehydrated andrographolide content＞andrographolide content＞chlorophyll content＞CuZn-SOD enzyme activity＞T-SOD enzyme activity； among different irradiation dose groups， the coefficient of variation was ranked as 100 Gy＞50 Gy＞200 Gy＞20 Gy＞10 Gy＞300 Gy＞0 Gy. The medial lethal dose was 195.10 Gy. According to the botanical traits， M1 generation of A. paniculata of 7 dose groups could be divided into 4 types. According to the property， M1 generation of A. paniculata of 7 dose groups could be divided into 3 types. CONCLUSIONS： The suitable irradiation dose interval for irradiating A. paniculata is 50-200 Gy.

OBJECTIVE： To study the effects of Sinorhizobium fredii， Rhizobium radiobacter and Azorhizobium caulinodans on germination of Andrographis paniculata seed under drought and salt stress condition. METHODS： Drought and salt stress models of A. paniculata seed were established with PEG-6000 （called “PEG” for short）and NaCl respectively. The effects of different concentrations of PEG （0.05， 0.10， 0.15， 0.20， 0.25 g/mL） and NaCl （50， 100， 150， 200 mmol/L） on the germination indicators （germination rate， germination potential， germination index， vigor index） of A. paniculata seed were investigated by the method of germination on dish paper. The seeds were soaked with S. fredii， R. radiobacter and A. caulinodans， and then germination indicators were investigated under the condition of drought and salt stress. RESULTS： Drought and salt stress models of A. paniculata seed were established with 0.15 g/mL PEG solution and 50 mmol/L NaCl solution， respectively. S. fredii pretreatment could significantly improve all the germination indicators of A. paniculata seed under drought stress condition， as well as germination index and vigor index of it under salt stress condition， but significantly reduce germination rate and germination index of it under salt stress condition （P＜0.05）. R. radiobacter treatment could significantly improve all the germination indicators of A. paniculata seed under drought stress condition， as well as germination potential， germination index and vigor index of it under salt stress condition （P＜0.05）. A. caulinodans pretreatment could significantly improve germination rate， germination index and vigor index of A. paniculata seed under drought stress condition， as well as germination rate and germination potential of it under salt stress condition （P＜0.05）. CONCLUSIONS： Three kinds of Rhizobia can improve germination ability of A. paniculata seed under drought or salt stress condition to different degrees. This research can provide technical support for planting and cultivation of A. paniculata under drought condition， and using saline-alkali soil as A. paniculata plantation area.