AIM: To investigate the influence of pterygium thickness and area on corneal refractive status.METHODS: Prospective longitudinal study. A total of 60 cases(60 eyes)of pterygium patients admitted to our hospital from January 2024 to September 2024 were randomly selected. All patients underwent pterygium excision combined with pedicle conjunctival flap transplantation for treatment. Optical coherence tomography(OCT)was used to measure the preoperative thickness of patient's pterygium, and a digital slit lamp microscope was used to measure the area of pterygium. The corneal refractive status(degree of corneal astigmatism and average curvature)and changes in uncorrected visual acuity of patients before surgery, 1 d, 1, and 3 mo after surgery were compared. The relationship between preoperative thickness and area of pterygium in patients and corneal refractive status indicators at different postoperative time points were analyzed, and Logistic regression was used to analyze the impact of pterygium thickness and area on postoperative visual improvement in patients.RESULTS: All patients completed follow-up after surgery for 3 mo. At 3 mo after surgery, visual acuity improved in 21 eyes(35%). The results of bivariate Pearson correlation analysis showed that the thickness and area of pterygium positively correlated with the degree of corneal astigmatism and uncorrected visual acuity before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05), and negatively correlated with the average corneal curvature before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05). Logistic regression analysis showed that the thickness and area of pterygium before surgery, high degree of corneal astigmatism, and low uncorrected visual acuity(large LogMAR value)were all risk factors for poor postoperative visual improvement in patients(OR>1, P<0.05). The large average corneal curvature before surgery was a protective factor for poor postoperative visual improvement in patients(OR<1, P<0.05).CONCLUSION: The increase in thickness and area of pterygium can, to some extent, improve corneal astigmatism, reduce the average curvature of the cornea, and affect postoperative visual recovery.

Hepatic osteodystrophy is a common complication in patients with chronic liver disease and is influenced by various risk factors， and it has become one of the important influencing factors for the prognosis of liver transplantation. By analyzing the influencing factors for bone health and bone metabolism during the perioperative period of liver transplantation， this article emphasizes the importance of a comprehensive assessment of bone health and necessary interventions at this stage， with an aim to reduce the risk of postoperative complications and improve the long-term prognosis of patients. A deeper exploration of the association between hepatic osteodystrophy and the prognosis of liver transplantation can help to reveal the key influencing factors for postoperative outcomes， thus providing a theoretical basis for optimizing postoperative management strategies. Furthermore， advances in this research field will offer new insights into the treatment of patients receiving liver transplantation， and it is expected to further improve quality of life and long-term survival rate.

Surgical robot is the national strategic diagnostic and therapeutic equipment research focus,get a number of scientific research institutes,colleges and universities and enterprises pay extensive attention to the design and development of a variety of surgical robots,and registration declaration.This article explores the critical technologies of surgical robots and key areas for optimizing their performance,including kinematic positioning errors,pose errors,feedback model errors,image recognition positioning errors,path planning,and safety aspects.The findings not only provide a scientific basis for future standardization research on surgical robots but also offer significant theoretical and practical references for the research,manufacturing,and registration processes in the medical robotics industry.

Objective:To explore the prevalence, clinical features, genetic characteristics and prognosis of Citrin deficiency in Henan province of China.Methods:A total of 986 565 neonates screened by tandem mass spectrometry at the Third Affiliated Hospital of Zhengzhou University from January 2013 to December 2021 were retrospectively analyzed. Analysis of SLC25A13 gene variants and parental verification were carried out for neonates suspected for Citrin deficiency by next-generation sequencing. The clinical, biochemical and genetic characteristics of Citrin deficiency patients were integrated to guide the diet treatment and follow up the growth and development. Paired- t test was used to compare the amino acid levels in the peripheral blood samples before and after the treatment. Results:Nine cases of Citrin deficiency were diagnosed among the 986 565 neonates. Specific elevation of citrulline was observed in all of the 9 cases. Six variants were detected by genetic sequencing, among which c. 852_855delTATG, c. 615+ 5G>A, c. 550C>T and IVS16ins3kb were known pathogenic variants, whilst c. 1111_1112delAT and c. 837T>A were unreported previously. The detection rate for c. 852_855delTATG was the highest (61.6%, 11/18), followed by IVS16ins3kb (16.7%, 3/18). The clinical symptoms of all patients were relieved after the treatment, and the blood amino acid profile and biochemical parameters were significantly improved by gradually falling within the normal range. By June 2022, all patients had shown a good prognosis.Conclusion:The prevalence of Citrin deficiency among neonates from Henan Province by tandem mass spectrometry is 1/109 618, and the carrier rate for the pathogenic variants of the SLC25A13 gene was 1/166. The c. 852_855delTATG may be a hot spot variant among the patients. Discovery of the novel variants has enriched the mutational spectrum of the SLC25A13 gene. Above results have provided a basis for the early diagnosis, treatment, prognosis and genetic counseling for the affected families.

Objective:To investigate the correlation between digital breast tomosynthesis(DBT)image features,pathological features,and the results of breast-conserving surgery(BCS)in early stage breast cancer.Methods:We retrospectively analyzed 422 cases of BCS resulting in successful breast preservation and 211 BCS cases that were followed by mastectomy.All of the patients underwent surgery at Tianjin Medical University Cancer Institute&Hospital between January 2019 and December 2023.Preoperative DBT images and clinicopathological features were assessed.A univariate Logistic regression analysis was performed to screen out the characteristics associated with BCS surgic-al results,after which multivariate Logistic regression analysis was performed to screen out the characteristics.Results:Univariate Logistic regression analysis showed that age(P=0.020),architectural distortion(P<0.001),breast composition(extremely dense,P=0.001),and mo-lecular subtype(Her2,P=0.001)were statistically different between the two groups.Multivariate Logistic regression analysis showed that ar-chitectural distortion(P<0.001),breast composition(extremely dense breast,P=0.003),and molecular subtype(Her2,P<0.001)differed signi-ficantly between the two groups.Conclusions:Breast composition,architectural distortion,and molecular subtype correlated with BCS res-ults.Extremely dense breast composition,architectural distortion,and Her2 subtype are associated with a higher possibility of conversion to mastectomy.These factors serve as effective predictive indicators of BCS results and thus aid clinicians in deciding the appropriate surgical strategies in the treatment of breast cancer.

Objective·To verify the accuracy and clinical feasibility of fluoroscopic stereophotogrammetric analysis(FSA)technology based on two dimension(2D)-three dimension(3D)registration for early migration detection of aseptic loosening of joint prostheses.Methods·2D-3D registration algorithms centering on the light source and projected object respectively in FSA technology were verified under various working conditions through image synthesis experiments,and the feasibility of clinical application was verified through real model experiments.The image synthesis experiment established a perspective projection environment with the same parameters as the real environment in a virtual environment,the 2D perspective images of the 3D model(bone or prosthesis)during the six degrees of freedom transformation were recorded,and the six degrees of freedom transformation of the 3D model was restored by using different 2D-3D registration algorithms.The error of each registration algorithm was calculated.For real model validation,the migration between bone and prosthesis after joint replacement surgery was simulated with a high precision bone prosthesis migration simulator.The 3D model of the bone or prosthesis was reconstructed by using computed tomograph(CT)images and optical scanning,and the 2D perspective images before and after prosthesis migration were captured by using a fluoroscopy device.The migration of the prosthesis was restored by using FSA technology based on 2D-3D registration,and the error of FSA technology was calculated.Results·The accuracy of the 2D-3D registration algorithm centering on the light source was higher than that of the algorithm centering on the projected object under different working conditions.When the initial registration conditions were favorable,the algorithm centering on the light source reduced the rotation error compared to the algorithm centering on the projected object,with a statistical difference(P=0.021),and the displacement error decreases,with a significant statistical difference(P=0.000).Moreover,algorithms centering on the light sources required lower similarity and fewer registration times to meet clinical application requirements.Conclusion·The accuracy of FSA technology based on 2D-3D registration in early migration detection of artificial joint prostheses meets clinical application requirements.This technology can warn of late aseptic loosening of prostheses by detecting early migration of prostheses after joint replacement surgery,and is expected to be applied to clinical practice through further research.

ObjectivesTo compare the clinical efficacy and complications of anatomic locking titanium plate （hereinafter referred to as “titanium plate screw”） and intramedullary nail in the treatment of distal tibial fractures.Methods From September 2019 to September 2021， 32 patients diagnosed with AO-A fracture of distal tibia at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were included in this study. Of these， 15 cases were treated with titanium plate screws and 17 cases were treated with intramedullary nails. General surgical indexes， fracture healing time and postoperative operation were compared between the two groups.ResultsAll patients were followed up for 10 to 20 months， with an average of 12 months. The operative time and intraoperative fluoroscopy times of intramedullary nail group were longer than those of titanium plate screw group， but the preoperative waiting time and hospitalization days was less or were fewer than those of titanium plate screw group， the difference was statistically significant （P < 0.05）. There was no significant difference in fracture healing time between the two groups （P> 0.05）. At 6 weeks after operation， VAS scores in both groups were lower than those before operation， with statistically significant difference （P<0.05）. There was no significant difference in VAS scores between the intramedullary nail group and the titanium plate screw group （P> 0.05）. AOFAS scores 6 months after surgery， ankle joint motion and complication rate 1 year after surgery in intramedullary screw group were better than those in titanium plate screw group， and the differences were statistically significant （P< 0.05）. There was no significant difference in AOFAS scores between the two groups at 1 year after operation （P> 0.05）.ConclusionTitanium plate screw and intramedullary nail are both effective methods for the treatment of distal tibial AO-A fracture， and there is no significant difference in long-term clinical efficacy. Intramedullary nail has fewer soft tissue complications， less impact on ankle motion， faster recovery and higher safety， while titanium plate screw has a higher probability of postoperative soft tissue infection. We suggest that in clinical work， preoperative evaluation of patients should be done well. Under the premise of grasping the indications， intramedullary nail has fewer complications and certain advantages.

Objective To explore the protective effect and possible mechanism of Periplaneta americana powder on rats with spinal cord injury.Methods Forty-eight male SD rats were randomly divided into sham operation,saline,Periplaneta americana powder,and Toll-like receptor 4(TLR4)inhibitor groups.Except for the sham operation group,a rat spinal cord hemi-transection injury model was established in the other three groups.The sham operation group received no treatment after the operation,saline and drug groups were subjected to intragastric administration of equal volumes of normal saline and Periplaneta americana powder(630 mg/kg),respectively,and the TLR4 inhibitor group was administered an intraperitoneal injection of TLR4 inhibitor(3 mg/kg).On days 1,3,7,and 14 after the operation,the motor function of rat hind limbs was evaluated by the Basso,Beattie,and Bresnahan(BBB)score.Histopathological changes of the spinal cord were observed by hematoxylin-eosin staining.Changes in the number of neurons were observed by immunohistochemistry.The levels of inflammatory factors IL-1,IL-6,IL-10,and TNF-α were measured by ELISA,and expression of TLR4,myeloid differentiation factor 88(MyD88),and NF-κB p65 was detected by Western Blot.Results Compared with the sham operation group,the BBB score and number of neurons in the saline group were significantly decreased,while the degree of pathological damage,and IL-1,IL-6,TNF-α,TLR4,MyD88,and NF-κB p65 levels were significantly increased(P＜0.05).Compared with the saline group,periplaneta americana powder and TLR4 inhibitor groups showed an increase in BBB scores and the number of neurons,and decreases in the degree of pathological damage and IL-1,IL-6,TNF-α,TLR4,MyD88,and NF-κB p65 levels(P＜0.05).Compared with the TLR4 inhibitor group,the periplaneta americana powder group had better increases in the BBB score,number of neurons and decreases in the degree of pathological damage and expression of IL-1 and TNF-α.Conclusions Periplaneta americana powder reduces the production of inflammatory factors after spinal cord injury by inhibiting the TLR4/MyD88/NF-κB pathway,protects nerves,and promotes motor recovery.

AIM: To understand the visual acuity and spectacle usage among primary and secondary school students in Xi'an city, providing scientific evidence for making myopia prevention and control efforts.METHODS:Vision screening and spectacles usage survey was conducted on 38 226 students in 119 primary and secondary schools from 16 counties and districts in Xi'an city, and uncorrected visual acuity, refractive power, glasses wearing rate, full correction rate were statistically analyzed.RESULTS:The myopia rate among primary and secondary school students in Xi'an city is 61.53%, showing an increasing trend as the grade level goes up(χ2trend=5332.203, P<0.01). Among them, the proportion of mild myopia decreases with the increase of grade level, while the proportion of moderate and high myopia shows an upward trend with the increase of grade level(χ2trend=2671.562, P<0.01). The glasses wearing rate among myopic students is 51.69%, showing an upward trend as the grade level goes up(χ2trend=1486.941, P<0.01). The spectacle prescription rate for female students is higher than that for male students(χ2=23.659, P<0.01), and the rate in urban areas is higher than that in suburban counties(χ2=102.241, P<0.01). The full correction rate among students wearing glasses is 67.08%, and the rate for students wearing glasses in urban areas is higher than that in suburban counties(χ2=4.980, P<0.05). Among myopic students, 63.66% had undergone visual acuity checks more than or equal to twice in the past year, with vocational high school students having the lowest frequency of twice vision screenings, accounting for 58.06%. There is a negative correlation between myopic students residing in suburban counties and their glasses wearing rate, while a higher grade level and increased frequency of annual vision checks are positively correlated with the glasses wearing rate among myopic students(all P<0.01).CONCLUSION:The situation of students' myopia prevention and control is severe in Xi'an city, with low rates of spectacles usage, full correction, and frequency of visual checks. Special attention needs to be paid to the vision correction status of students in suburban counties, primary schools, and vocational high schools.

Objective:To systematically evaluate and integrate the qualitative research of the practical experience and practical difficulties of advance care planning (ACP), so as to provide a reference for subsequent clinical nurses to better carry out ACP.Methods:PubMed, Web of Science, Embase, Cochrane Library, CINAHL, CNKI, Wanfang, VIP, Chinese Biomedical Literature Database were collected the qualitative research on the practical experience and practical difficulties of nurses′advance care planing, and the search time was the database establishment until August 1, 2022. Literature quality evaluation was conducted by the Joanna Briggs Institute (JBI) (2016), and the results were summarized using Meta integration method.Results:A total of 13 studies were included, and 39 studies were summarized into 11 new categories, forming 4 integrated results: nurses′ cognition of ACP practice, emotional experience of nurses′ ACP practice, personal factors that hinder ACP practice, and external environmental factors that hinder ACP practice.Conclusions:In ACP practice, nurses should be actively guided to have positive cognitive and emotional experience to improve their competence in ACP practice. At the same time, government departments should be united to support, integrate hospitals, society and other forces to formulate coping strategies against obstacles, so as to promote the development and practice of ACP.