With the advent of the refractive era of cataract surgery, postoperative residual refractive error has become a key factor affecting visual quality. The accuracy of intraocular lens(IOL)power calculation is affected by multiple factors, including ocular biological parameters, calculation formulas, and lens constants. Currently, the lens constants widely used in clinical practice are mostly based on Western populations, which have a mismatch with the ocular characteristics of the Chinese population, such as shorter axial length and steeper cornea. Therefore, the personalized optimization of the constant has become a research hotspot. This review primarily summarizes the research progress on lens constant optimization in improving the accuracy of IOL power calculation. Currently, there is no consensus on lens constant optimization methods. Single-constant formulas can be optimized through iterative methods, while multi-constant formulas require the combination of linear or nonlinear strategies. Simplified gradient descent and data-driven techniques offer new optimization pathways, but cross-validation is needed to evaluate their performance. Segmented optimization based on axial length, corneal curvature, and anterior chamber depth has shown significant effectiveness in patients with special anatomical structures, effectively reducing postoperative refractive errors in different patient groups, but limitations remain in some extreme cases. The interaction of multiple parameters significantly impacts the predictive accuracy of complex cases. While new-generation formulas integrating multiple parameters or incorporating AI algorithms have improved accuracy, constant optimization still holds value. Currently, the complex relationships between multiple parameters and intraoperative dynamic changes require further in-depth research. Future research, including targeted population optimization studies, the development of real-time monitoring technologies, and innovative IOL designs, may make achieving zero postoperative refractive error a possibility.

A 51-year-old male presented with nasal obstruction, followed by progressive hearing loss and blurred vision. Imaging identified space-occupying lesions in the paranasal sinuses, orbits, and paraspinal regions, while laboratory tests confirmed positive anti-proteinase 3 anti-neutrophil cytoplasmic antibody(PR3- ANCA) immunoglobulin G (IgG)and markedly elevated serum IgG4. Despite treatment with corticosteroids, immunosuppressants, and radiotherapy, the patient exhibited steroid dependency with relentless disease progression. Following multidisciplinary consultation, a diagnosis of inflammatory myofibroblastic tumor (IMT) coexisting with ANCA- associated vasculitis (AAV) was favored, though IgG4-related disease remained a critical differential. Ultimately, profound immunosuppression precipitated a severe herpesvirus infection, leading to disseminated intravascular coagulation and multiple organ dysfunction syndrome. This case underscores the rarity and diagnostic complexity of concurrent IMT and AAV, highlights the therapeutic dilemma of balancing primary disease control against fatal opportunistic infections, and emphasizes the critical role of multidisciplinary collaboration in the diagnosis and treatment of complex diseases.

ObjectiveTo explore the clinical efficacy and mechanism of Bupi Qingfei prescription （BPQF） in treating stable bronchiectasis in the patients with syndromes of lung-spleen Qi deficiency and phlegm-heat accumulation in the lungs. MethodsA randomized， double-blind， placebo-controlled trial was conducted. Patients were randomized into BPQF and placebo control （PC） groups. On the basis of conventional Western medicine treatment， the BPQF granules and placebo were respectively administered at 10 g each time， twice a day， for a course of 24 weeks. The TCM symptom scores， Quality of Life Questionnaire for Bronchiectasis （QOL-B） scores， lung function indicators， T lymphocyte subsets， level of inflammatory factors in the sputum， level of neutrophil elastase （NE） in the sputum， and occurrence of adverse reactions were observed before and after treatment in the two groups. ResultsA total of 64 patients completed the study， encompassing 32 in the BPQF group and 32 in the PC group. After treatment， the BPQF group showed decreased TCM symptom scores （P<0.01）， increased QOL-B scores （P<0.01）， and declined levels of tumor necrosis factor （TNF）-α and NE （P<0.05， P<0.01）. The PC group showed decreased TCM symptom （except spleen deficiency） scores （P<0.01）， increased the QOL-B health cognition and respiratory symptom domain scores （P<0.05， P<0.01）， and a declined TNF-α level （P<0.01）. Moreover， the BPQF group had lower TCM symptom （except chest tightness） scores （P<0.05， P<0.01）， higher QOL-B （except treatment burden） scores （P<0.05， P<0.01）， and lower levels of interleukin-6 and TNF-α （P<0.05） than the PC group. Neither group showed serious adverse reactions during the treatment process. ConclusionBPQF can ameliorate the clinical symptoms of stable bronchiectasis patients who have lung-spleen Qi deficiency or phlegm-heat accumulation in the lungs by regulating the immune balance and inhibiting airway inflammatory responses.

Objective To develop an automated system for the determination of gross α and gross β activity concentrations in water, and to support the rapid and automated monitoring of environmental water bodies. Methods Based on the thick source method, microwave evaporation-ashing was used to replace conventional electric hotplate heating. A grinder and a sample-spreading device were designed and operated via a robotic arm, achieving fully automated pretreatment, sample preparation, and measurement. Results Spike recovery tests demonstrated that the recovery rates were 95.7%-102.5% for gross α and 97.2%-108.1% for gross β. The relative standard deviations were 4.1%-7.8% for gross α and 5.9%-7.7% for gross β. Compared with manual laboratory methods, the average relative errors were 2.17%-6.25% for gross α and 4.17%-6.90% for gross β. The sample preparation time was reduced from an average of 72 hours to less than 5 hours, representing an efficiency improvement of over 90%. Conclusion The developed system enables rapid, accurate, and fully automated monitoring of gross α/β radioactivity, making it suitable for online monitoring of environmental water bodies. It can provide timely data on the radiological indicators of water bodies for environmental protection and water resource management authorities.

Background/Aims: The pathophysiology of refractory gastroesophageal reflux disease (RGERD), which differs from proton pump inhibitor dependent gastroesophageal reflux disease (DGERD), remains incompletely elucidated. This study aims to compare esophageal motility patterns, transdiaphragmatic pressure gradients (TPG), and reflux profiles between RGERD and DGERD patients, and to delineate dynamic pressure gradient-esophagogastric junction (EGJ) interactions in these patients. Methods: In this retrospective study, 274 patients who underwent 24-hour impedance-pH monitoring and high-resolution manometry, along with an assessment of proton pump inhibitor responsiveness, were classified as RGERD (32.5%), DGERD (54.4%), or non-GERD (13.1%). Clinical characteristics, TPG, esophageal motility, and reflux metrics were compared between RGERD and DGERD patients. Subgroup analysis excluding hiatal hernia (HH) was conducted to investigate the pathophysiology of RGERD. Results: The RGERD group exhibited a significantly higher proportion of chest pain compared to the DGERD group. Regarding reflux profiles, RGERD patients without HH (RGERDHH- group) experienced increased weakly acidic reflux (P < 0.001) and prolonged bolus exposure (P = 0.006) compared to their counterparts (DGERDHH- group). Mechanistically, the RGERDHH- group showed reduced lower esophageal sphincter basal pressure (P = 0.010) and EGJ contractile integral (P = 0.005). Notably, following a wet-swallow, the RGERDHH- group experienced the significant elevation in gastric pressure and TPG. Correlation analyses revealed weakly acidic reflux and bolus exposure were positively correlated with gastric pressure variation, and inversely correlated with lower esophageal sphincter basal pressure. Conclusions Transient gastric pressure elevation and compromised EGJ barrier function drive weakly acidic reflux and esophageal bolus exposure. This pressure gradient-barrier mismatch underpins the refractoriness of RGERD.

Objective: To analyze the serological phenotypes and molecular genetic characteristics of a proband with ABO forward and reverse typing discrepancy and their family members, and to investigate the molecular genetic mechanism underlying the Ael/AelB phenotype caused by the c. 575T>C variant on an ABO A1.02 background. Methods: Serological testing and adsorption-elution assays were performed for blood group identification of the proband and family members. PCR-SBT, cloning sequencing, and Nanopore third-generation sequencing were used to analyze ABO gene variants and haplotypes. Phyre2 and PyMOL were used to predict the effect of the p. Ile192Thr variant on the structure of glycosyltransferase A (GTA), and plasma GTA activity was evaluated using an in vitro transferase assay. Results: Among thirteen family members, four members showed a serological phenotype consistent with the Ael subtype and one with the AelB subtype. Cloning sequencing and third-generation sequencing confirmed that five family members carried the ABO A1.02 (c. 575T>C) variant, which co-segregated with the weak A phenotype in the family. Structural modeling suggested that p. Ile192Thr may alter the local spatial conformation and hydrogen-bond interactions of GTA. Plasma GTA activity testing showed markedly reduced GTA activity in the tested individuals. Conclusion: The ABO A1.02 (c. 575T>C) variant is associated with the Ael/AelB phenotype. The p. Ile192Thr substitution may weaken A antigen expression by altering GTA conformation and reducing enzymatic activity. This study provides additional evidence for the role of this variant in the Ael/AelB phenotype from the perspectives of familial inheritance, full-length haplotype analysis, and functional assessment, which is important for accurate ABO subtype identification and individualized transfusion strategies.

Cremastrae Pseudobulbus Pleiones Pseudobulbus is a Chinese medicinal material used for clearing heat， detoxicifying， resolving phlegm， and dissipating nodules. It is derived from Cremastra appendiculata， Pleione bulbocodioides， or Pleione yunnanensis， as recorded in the 2025 edition of the Pharmacopoeia of the People′s Republic of China， with the former known as Maocigu and the latter two known as Bingqiuzi. Current antitumor studies mainly focus on polysaccharides， water-extracted alcohol-precipitated fractions， and purified extracts of C. appendiculata. Structurally characterized glucomannans suppress breast and liver tumor xenografts and exhibit immunomodulatory effects. The water-extracted alcohol-precipitated fractions inhibit tumor angiogenesis in hepatoma-bearing mice. A purified C. appendiculata extract standardized to five phenanthrene and bibenzyl constituents induces mitochondrial apoptosis in hepatocellular carcinoma cells. Reported pharmacological effects involve cell-cycle regulation， apoptosis， epithelial-mesenchymal transition， angiogenesis， autophagy， and the tumor immune microenvironment， with phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR）， Wnt/β-catenin， and Janus kinase 2/signal transducer and activator of transcription 3 （JAK2/STAT3） signaling pathways being the major mechanism links. Quality evaluation of Cremastrae Pseudobulbus Pleiones Pseudobulbus has progressed from single-marker assays to an integrated approach involving botanical authentication， chromatographic fingerprinting， multicomponent analysis， and evaluation of associations between blood-absorbed constituents and antitumor effects. Militarine and dactylorhin A can be used for botanical identification and batch evaluation， and in vivo exposure data from related orchids are concentrated on militarine. Quantitative associations between these constituents and antitumor effects remain to be established. Clinical evidence mainly focuses on formula-based applications and expert experience. Comparative antitumor data in hepatoma models are available for the commercial specifications of Maocigu and Bingqiuzi， whereas parallel evaluations of pharmacological effects， safety windows， and drug interactions among the three official botanical origins remain insufficient. The major limitations are the incomplete standardization of botanical origins and preparations and the lack of quantitative links among quality markers， systemic exposure， antitumor effects， and toxicity endpoints， which constrain reproducible pharmacological evaluation and clinical translation of Cremastrae Pseudobulbus/Pleiones Pseudobulbus.

Objective: To examine the association between parent-child communication frequency about school related matters and depressive symptom risk among children and adolescents and to characterize its dose response pattern, so as to provide a reference for family intervention and school mental health promotion. Methods: Data were obtained from the 2022 China Family Panel Studies(CFPS), conducted from May to December 2022. A total of 1 896 children and adolescents aged 10-15 years were included. The 8 item Center for Epidemiologic Studies Depression Scale (CES-D8) was adopted to assess depressive symptoms among children and adolescents. Data on the parent-child communication frequency about school related matters was obtained from CFPS Child Proxy Questionnaire. Multivariable Logistic regression, sensitivity analyses, and exploratory segmented regression were performed. Results: A total of 375 participants were screened positive for depressive symptoms, with a prevalence of 19.8%. The prevalence decreased from 23.3% in the "never" group to 10.6% in the "very often" group ( χ 2=19.30, P <0.05). In the fully adjusted model, the point estimate for the "very often" group suggested lower odds of a positive screen ( OR =0.52), and the test for trend was statistically significant ( P =0.03). The association was more pronounced among children aged 10-12 years ( OR=0.31, 95%CI=0.11-0.86, P <0.05). Sensitivity analyses yielded directionally consistent results, but the statistical evidence was weakened ( OR=0.83, P trend =0.08). Dose response analysis showed a statistically significant overall association between parent-child communication frequency about school related matters and depressive symptom risk ( P =0.04), with no significant departure from linearity ( P = 0.14 ). Among the prespecified cut points, exploratory segmented regression showed relatively better model fit at an ordinal frequency score of 4.5, between "often" and "very often" (likelihood ratio test P =0.03). However, the overall test for nonlinearity was not statistically significant ( P =0.14), and the finding should therefore be interpreted as exploratory. Conclusion More frequent parent-child communication about school related matters is associated with lower depressive symptom risk, suggesting that routine communication about such matters may help reduce the risk of depressive symptoms in children and adolescents.

ObjectiveCurrently， evidence regarding whether the left or right nostril should be preferentially selected for nasotracheal intubation （NTI） in children remains insufficient， particularly under continuous visualization conditions. This study aimed to compare the efficiency and safety of NTI via the left versus right nostril in children under flexible intubation video endoscope （FIVE） guidance. MethodsA total of 100 children aged 3-7 years with American Society of Anesthesiologists physical status I-II， who were scheduled for elective dental caries treatment under general anesthesia， were randomly assigned to undergo FIVE-guided NTI via either the left nostril （group L） or the right nostril （group R）. The primary outcome was intubation time. Secondary outcomes included first-attempt success rate， number of intubation attempts， incidence and severity of epistaxis， peri-intubation hemodynamic and respiratory parameters， and postoperative procedure-related complications （nasal blockage， sore throat， and hoarseness）. ResultsNo statistically significant between-group difference was found in intubation time （L group： 36.86 ± 6.04 s vs. R group： 37.96 ± 6.20 s； P=0.371） or first-attempt success rate （96% vs. 92%， respectively； P=0.400）. The incidence and severity of epistaxis were comparable between groups （10% vs. 12%； P=0.749）. No statistically significant between-group differences were observed in hemodynamic and respiratory parameters at all measured time points （all P>0.05）. The incidences of postoperative nasal congestion， sore throat， and hoarseness were low in both groups. ConclusionIn children undergoing FIVE-guided NTI， tracheal catheter insertion via the left or right nostril yields comparable efficacy and safety. When using visualization-guided techniques in routine pediatric clinical practice， nostril laterality does not need to be prioritized when selecting the insertion side for NTI.

To explore the clinical significance of decreased serum immunoglobulin (Ig) A levels in patients with IgG4-related disease (IgG4-RD).