With the continuous development of refractive surgery, people's focus has gradually shifted from improving vision to improving visual quality, and personalized laser-assisted in situ keratomileusis(LASIK)surgery has gradually become people's preferred choice. Femtosecond laser-assisted keratoplasty provides better advantages for personalized LASIK surgery. This article mainly introduces the commonly used femtosecond laser-assisted personalized LASIK surgery(FS-LASIK)in recent years, such as wavefront-optimized, wavefront-guided, topography-guided, Q value-guided(aspheric cutting), personalized surgery “Wavelight Plus” and personalized surgery when correcting patients with age-related inadequate accommodation. This article focuses on analyzing the advantages and disadvantages of different personalized FS-LASIK, as well as the research progress in recent years, and also focuses on comparing the differences between different personalized surgeries.

Objective To investigate the potential value of exosomes derived from rat ectoderm mesenchymal stem cells(EMSCs-exo)for repairing secondary spinal cord injury.Methods EMSCs-exo were obtained using ultracentrifugation from EMSCs isolated from rat nasal mucosa,identified by transmission electron microscope,nanoparticle tracking analysis(NTA),and Western blotting,and quantified using the BCA method.Neonatal rat microglia purified by differential attachment were induced with 100 μg/L lipopolysaccharide(LPS)and treated with 37.5 or 75 mg/L EMSCs-exo.PC12 cells were exposed to 400 μmol/L H2O2 and treated with EMSCs-exo at 37.5 or 75 mg/L.The protein and mRNA expressions of Arg1 and iNOS in the treated cells were determined with Western blotting and qRT-PCR,and the concentrations of IL-6,IL-10,and IGF-1 in the supernatants were measured with ELISA.The viability and apoptosis of PC12 cells were detected using CCK-8 assay and flow cytometry.Results The isolated rat EMSCs showed high expressions of nestin,CD44,CD105,and vimentin.The obtained EMSCs-exo had a typical cup-shaped structure under transmission electron microscope with an average particle size of 142 nm and positivity for CD63,CD81,and TSG101 but not vimentin.In LPS-treated microglia,EMSCs-exo treatment at 75 mg/L significantly increased Arg1 protein level and lowered iNOS protein expression(P<0.05).EMSCs-exo treatment at 75 mg/L,as compared with the lower concentration at 37.5 mg/L,more strongly increased Arg1 mRNA expression and IGF-1 and IL-10 production and decreased iNOS mRNA expression and IL-6 production in LPS-induced microglia,and more effectively promoted cell survival and decreased apoptosis rate of H2O2-induced PC12 cells(P<0.05).Conclusion EMSCs-exo at 75 mg/L can effectively reduce the proportion of M1 microglia and alleviate neuronal apoptosis under oxidative stress to promote neuronal survival,suggesting its potential in controlling secondary spinal cord injury.

Objective:To investigate the midterm and long-term efficacy of flow-diverter device in treating intracranial aneurysms (IAs) and analyze its clinical outcomes in anterior circulation aneurysms and posterior circulation aneurysms.Methods:This is a retrospective case series study. The data of 566 intracranial aneurysm patients (681 aneurysms) treated with the flow-diverter device at Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2021 were retrospectively analyzed. There were 205 males and 361 females, with an age ( M(IQR)) of 55 (14) years (range:18 to 77 years). Twelve patients (12 aneurysms) had ruptured aneurysms before surgery, and 75 patients (172 aneurysms) had multiple aneurysms. Preoperative modified Rankin scale (mRS) >2 points in 16 patients.There were 444 patients (552 aneurysms) in the anterior circulation group and 122 patients (129 aneurysms) in the posterior circulation group. Postoperative follow-up was conducted via outpatient visits or telephone calls at 3 to 12 months after the procedure. Baseline aneurysm parameters, surgical information, and imaging and clinical outcomes were collected. Univariate and multivariate Logistic regression analyses were used to identify independent factors associated with long-term incomplete aneurysm occlusion. Results:Intraoperative use of flow diverter-assisted coil embolization was performed in 221 patients (226 aneurysms), and balloon assistance was used in 20 patients (22 aneurysms).The intraoperative rupture rate was 0.5% (3/566), and the intraoperative thrombosis rate was 0.7% (4/566). The in-hospital mortality rate was 1.2% (7/566). Postoperative complications included subarachnoid hemorrhage in 5 patients (0.9%), intracerebral hemorrhage in 2 patients (0.4%), ischemic stroke in 19 patients (3.6%), and transient ischemic attack in 16 patients (3.0%). Imaging follow-up was available for 447 patients (548 aneurysms) with a follow-up duration of (16.7±6.7) months (range:3 to 45 months). Incomplete aneurysm occlusion occurred in 79 patients (95 aneurysms), accounting for 17.3% (95/548). Parent artery stenosis was observed in 63 patients (72 aneurysms), accounting for 13.1% (72/548). Clinical follow-up was available for 530 patients (644 aneurysms) with a follow-up duration of (29.4±11.3) months (range:3 to 54 months). One case of mRS score >2 points was observed in 18 patients, accounting for 3.4% (18/530). Among them, the rate of incomplete occlusion in the anterior and posterior circulation group was 16.9% (76/450) and 19.4% (19/98), respectively, and the rate of parent artery stenosis was 10.9% (49/450) and 23.5% (23/98), respectively; the rate of mRS score>2 points was 2.4% (10/415) and 7.0% (8/115), respectively. Univariate and multivariate Logistic regression analysis showed that aneurysm neck size ( β=0.075, OR=1.08, P=0.028) and coil use ( β=-1.070, OR=0.034, P=0.001) were independent factors influencing long-term aneurysm occlusion. Conclusions:The flow-diverter device demonstrates good safety and efficacy in the midterm and long-term treatment of overall IAs. However, further research is needed to focus on the midterm and long-term treatment outcomes of aneurysms with relatively wide neck and posterior circulation aneurysms.

Objective To investigate the protective effect of target temperature management based different durations with delayed hypothermia for traumatic brain injury(TBI)in rats.Methods 36 healthy adult male SD rats were randomly divided into NT group,HT4h group,HT24h group and HT48h group.The TBI model of rats was prepared with an electronic controllable cortical injury device.NT group was treated with normal temperature(37℃)4 h after TBI,and the experimental groups were treated with low temperature(33.0±1.0℃)4 h after TBI for 4 h,24 h,and 48 h.Three days after TBI,the motor function of the rats in each group was evaluated by beam walking test and inclined-grid climbing test,EB staining was used to measure the blood-brain barrier perme-ability,the change of hippocampal neurons was observed by Nissl staining,the expression of DCX and GFAP was detected by immunofluorescence,and the expression of Bcl-2 and Bax was measured by Western blot and immuno-histochemistry.Results Compared with NT group,the experimental groups could significantly improve the motor function of TBI rats,reduce the permeability of blood-brain barrier,protect hippocampal neurons,promote DCX expression,inhibit GFAP expression,up-regulate the expression of Bcl-2 protein,and down-regulate the expres-sion of Bax protein.However,the protective effect was more apparent in HT48h group than other experimental groups(P<0.05).Conclusion Long-term delayed target temperature management has a significant brain protective effect.

Objective To investigate the potential value of exosomes derived from rat ectoderm mesenchymal stem cells(EMSCs-exo)for repairing secondary spinal cord injury.Methods EMSCs-exo were obtained using ultracentrifugation from EMSCs isolated from rat nasal mucosa,identified by transmission electron microscope,nanoparticle tracking analysis(NTA),and Western blotting,and quantified using the BCA method.Neonatal rat microglia purified by differential attachment were induced with 100 μg/L lipopolysaccharide(LPS)and treated with 37.5 or 75 mg/L EMSCs-exo.PC12 cells were exposed to 400 μmol/L H2O2 and treated with EMSCs-exo at 37.5 or 75 mg/L.The protein and mRNA expressions of Arg1 and iNOS in the treated cells were determined with Western blotting and qRT-PCR,and the concentrations of IL-6,IL-10,and IGF-1 in the supernatants were measured with ELISA.The viability and apoptosis of PC12 cells were detected using CCK-8 assay and flow cytometry.Results The isolated rat EMSCs showed high expressions of nestin,CD44,CD105,and vimentin.The obtained EMSCs-exo had a typical cup-shaped structure under transmission electron microscope with an average particle size of 142 nm and positivity for CD63,CD81,and TSG101 but not vimentin.In LPS-treated microglia,EMSCs-exo treatment at 75 mg/L significantly increased Arg1 protein level and lowered iNOS protein expression(P<0.05).EMSCs-exo treatment at 75 mg/L,as compared with the lower concentration at 37.5 mg/L,more strongly increased Arg1 mRNA expression and IGF-1 and IL-10 production and decreased iNOS mRNA expression and IL-6 production in LPS-induced microglia,and more effectively promoted cell survival and decreased apoptosis rate of H2O2-induced PC12 cells(P<0.05).Conclusion EMSCs-exo at 75 mg/L can effectively reduce the proportion of M1 microglia and alleviate neuronal apoptosis under oxidative stress to promote neuronal survival,suggesting its potential in controlling secondary spinal cord injury.

Objective:To investigate the midterm and long-term efficacy of flow-diverter device in treating intracranial aneurysms (IAs) and analyze its clinical outcomes in anterior circulation aneurysms and posterior circulation aneurysms.Methods:This is a retrospective case series study. The data of 566 intracranial aneurysm patients (681 aneurysms) treated with the flow-diverter device at Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2021 were retrospectively analyzed. There were 205 males and 361 females, with an age ( M(IQR)) of 55 (14) years (range:18 to 77 years). Twelve patients (12 aneurysms) had ruptured aneurysms before surgery, and 75 patients (172 aneurysms) had multiple aneurysms. Preoperative modified Rankin scale (mRS) >2 points in 16 patients.There were 444 patients (552 aneurysms) in the anterior circulation group and 122 patients (129 aneurysms) in the posterior circulation group. Postoperative follow-up was conducted via outpatient visits or telephone calls at 3 to 12 months after the procedure. Baseline aneurysm parameters, surgical information, and imaging and clinical outcomes were collected. Univariate and multivariate Logistic regression analyses were used to identify independent factors associated with long-term incomplete aneurysm occlusion. Results:Intraoperative use of flow diverter-assisted coil embolization was performed in 221 patients (226 aneurysms), and balloon assistance was used in 20 patients (22 aneurysms).The intraoperative rupture rate was 0.5% (3/566), and the intraoperative thrombosis rate was 0.7% (4/566). The in-hospital mortality rate was 1.2% (7/566). Postoperative complications included subarachnoid hemorrhage in 5 patients (0.9%), intracerebral hemorrhage in 2 patients (0.4%), ischemic stroke in 19 patients (3.6%), and transient ischemic attack in 16 patients (3.0%). Imaging follow-up was available for 447 patients (548 aneurysms) with a follow-up duration of (16.7±6.7) months (range:3 to 45 months). Incomplete aneurysm occlusion occurred in 79 patients (95 aneurysms), accounting for 17.3% (95/548). Parent artery stenosis was observed in 63 patients (72 aneurysms), accounting for 13.1% (72/548). Clinical follow-up was available for 530 patients (644 aneurysms) with a follow-up duration of (29.4±11.3) months (range:3 to 54 months). One case of mRS score >2 points was observed in 18 patients, accounting for 3.4% (18/530). Among them, the rate of incomplete occlusion in the anterior and posterior circulation group was 16.9% (76/450) and 19.4% (19/98), respectively, and the rate of parent artery stenosis was 10.9% (49/450) and 23.5% (23/98), respectively; the rate of mRS score>2 points was 2.4% (10/415) and 7.0% (8/115), respectively. Univariate and multivariate Logistic regression analysis showed that aneurysm neck size ( β=0.075, OR=1.08, P=0.028) and coil use ( β=-1.070, OR=0.034, P=0.001) were independent factors influencing long-term aneurysm occlusion. Conclusions:The flow-diverter device demonstrates good safety and efficacy in the midterm and long-term treatment of overall IAs. However, further research is needed to focus on the midterm and long-term treatment outcomes of aneurysms with relatively wide neck and posterior circulation aneurysms.

The Peking Union Medical College School of Nursing has been dedicated to exploring the education of undergraduate students specializing in geriatric nursing since 2016. Through seven years of exploration and practice, aiming at the pain points and difficulties in the process of cultivating geriatric nursing students, the teaching team has developed a progressive and modular curriculum system, with the goal of training geriatric nursing professionals with specialized knowledge and practical innovation abilities, on the platform of a seamless teaching practice base connecting settings from laboratory to community/elderly care institutions/hospital to society, with an emphasis on the integration of ideological and political education with geriatric nursing education. Moreover, a specialized faculty team has been established. This course serves as a model for nurturing excellent nursing professionals possessing the right values and outlook on life as well as ability to cope with the national challenges posed by aging populations.

【Objective】 To investigate the factors influencing the length of hospital stays of the acute fatty liver of pregnancy (AFLP) patients, so as to establish the prediction model. 【Methods】 A total of 49 patients diagnosed as AFLP)in ShenZhen People’s Hospital between January 2008 and January 2023 were retrospectively analyzed. According to the median length of hospital stays, the patients were divided into two groups: Group A(n=21)and Group B(n=28). Preoperative general laboratory data, clinical features and postpartum adverse outcomes in both groups were analyzed. Multivariate binary logistic regression was used to analyze the independent factors affecting the length of hospital stays for AFLP, and a prediction model for hospitalization time was established. 【Results】 Comparison between Group B and Group A were as follows: hospital stays(d)(15.5 vs 8), preoperative icterus(%)[16(57.1%)vs 3(14.3%)], thrombin time(TT)(s)(24.2 vs 21.3), prothrombin time(PT)(s)(16.8 vs 15.3), activated partial thromboplastin time(APTT)(s)(52.3 vs 40.7), total bilirubin(TBIL)(μmol/L)(77.2 vs 45.2), indirect bilirubin(IBIL)(μmol/L)(21.2 vs 10), creatinine(Cre)(μmol/L)[(171.97±53.34) vs (131.81±45.06]), TT extension(%)[24(85.7%)vs 11(52.4%)], APTT extension(%)[27(96.4%)vs 7(33.3%)], IBIL elevation(%)[19(67.9%)vs 4(19%)], Cre concentration rise(%)[21(75%)vs 8(38%)], number of postpartum plasma exchange sessions(%)[23(82.1%)vs 5(23.8%)], postpregnancy co-infection phenomenon(%)[21(75%)vs 4(19%)], with Group B significantly higher than Group A. The preoperative platelet count(×10⁹/L)(128 vs 221)and the concentration of fibrinogen(g/L)[0.9 vs 1.6] in Group B were significantly lower than those in Group A. Univariate logistic regression analysis showed that preoperative icterus, postpregnancy co-infection phenomenon, number of postpartum plasma exchange sessions, preoperative TT extension, preoperative APTT extension, Cre concentration rise were influencing factors for the hospital stays of AFLP patients. According to the minimum result of Akaike information criterion, the multivariate binary logistic regression analysis (step-wise selection) showed that the number of postpartum plasma exchange sessions, icterus, preoperative APTT extension were the independent risk factor influencing the hospital stays of AFLP patients, and the logistic regression prediction model was established by incorporating the above three factors. Regularization techniques were further employed in linear regression to address and assess overfitting issues. Additionally, the confidence interval for the estimated effect sizes in each model have been acquired by bootstrapping techniques. 【Conclusion】 Preoperative icterus, preoperative APTT extension(APTT>43s)and the number of postpartum plasma exchange sessions were the independent risk factor influencing the hospital stays of AFLP patients and the logistic regression prediction model with high predictive effectiveness was established successfully.

Objective: To estimate the epidemic threshold and graded intensity thresholds of influenza in Zhejiang Province from 2012 to 2023 using the moving epidemic method (MEM), and evaluate the intensity of influenza epidemics, so as to provide the reference for influenza prevention and control in Zhejiang Province. Methods: The positive rates of influenza virus per week during the influenza epidemic seasons (from 40th week to 20th week of the following year) in Zhejiang Province from 2012 to 2022 were collected through the Chinese Influenza Surveillance Information System. A MEM model was established and optimized using cross-validation. The maximum accumulated rates percentage was used to divide the epidemic into pre-epidemic, epidemic, and post-epidemic periods, and to estimate the epidemic thresholds and graded intensity thresholds. The intensity of influenza epidemics in Zhejiang Province during the 2022-2023 epidemic season were assessed. Results: The positive rates of influenza virus in five epidemic seasons from 2012 to 2022 were included in the model. The MEM model performed best when the parameter δ was set to 1.5, with a sensitivity of 0.971, a specificity of 0.745, and a Youden's index of 0.716. According to the model analysis, the epidemic beginning and ending thresholds of influenza in Zhejiang Province during the 2022-2023 epidemic season were 19.32% and 10.92%, respectively, and the medium, high, and extremely high intensity thresholds were 48.65%, 63.49%, and 68.47%, respectively. During 2022-2023, the influenza epidemic was in the pre-epidemic period from the 40th week in 2022 to the 7th week in 2023; the epidemic period was from the 8th to the 18th week, the epidemic intensity was low in the 8th week and increased to a high level in the 9th week, and reached to a extremely high level from the 10th to the 13th week, then fell to the high and the medium level in the 14th week and 15th week, respectively, and fell to a low level from the 16th to the 18th week; the influenza epidemic entered the post-epidemic period since the 19th week. Conclusion MEM could be applied for evaluation of influenza epidemic intensity, providing the reference for early identification and taking graded preventive and control measures.

Sarcomatoid carcinoma of the renal pelvis accounts for a very low percentage of malignant tumors in the renal pelvis and has a poor prognosis. This article reported a patient with sarcomatoid carcinoma of the renal pelvis. The patient presented with macroscopic hematuria as the first symptom, and CT suggested left renal occupancy, unilateral nephrectomy was performed, and pathology suggested sarcomatoid carcinoma of the renal pelvis. Three weeks after surgery, a follow-up CT showed tumor recurrence. Programmed death 1(PD-1)inhibitor was given once every 3 weeks. Repeated CT examination after 24 weeks of continuous treatment suggested that the recurrent tumor disappeared. The patients was followed-up for 42 months without tumor recurrence or metastasis.