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.

Objective:To investigate the expression of protein kinase D2(PRKD2)in bladder cancer(BLCA)tissue using bioinformatics analysis method and its effect on the prognosis of BLCA patients,and to clarify the role of PRKD2 in the occurrence and development of BLCA.Methods:The data from 9 normal bladder samples,19 BLCA paracancerous samples,and 407 BLCA tumor samples were downloaded from the UCSC Cancer Genome Database.The Mann-Whitney U test was applied to analyze the difference in expression of PRKD2 mRNA in BLCA tumor and normal bladder tissues,and the Human Protein Atlas(HPA)database was used for proteomic validation.DESeq2 package in R software was applied to screen the differentially expressed genes(DEGs)in BLCA tissue in PRKD2 low-and high-expression groups.The co-expression heatmaps of PRKD2 were plotted using the ggplot2 package,Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)were used for functional annotation analysis and pathway enrichment analysis of DEGs,and Gene Set Enrichment Analysis(GSEA)was used to obtain the gene sets that were significantly enriched for DEGs.The BLCA samples were divided into low-and high-expression groups according to the expression level of PRKD2,and the correlations between PRKD2 expression and immune cell infiltration in the BLCA patients were analyzed with GSVA package.The relationship between PRKD2 and prognosis of BLCA patients was further analyzed using the survival package and the survminer package.The PRKD2 gene mutations in BLCA tissue were analyzed using the cBioPortal database.The cystitis,bladder polyp and BLCA tissues were collected,and the expression levels of interleukin-17F(IL-17F)protein in BLCA and control tissues were detected using immunohistochemical staining technique.Results:PRKD2 was highly expressed in a variety of malignant tumors,and the expression levels of PRKD2 mRNA and protein in BLCA tissue were significantly increased compared with those in normal bladder tissue(P＜0.05).Single gene differential analysis of PRKD2 yielded a total of 1 058 DEGs,of which a total of 29 genes were up-regulated and 1 029 were down-regulated.The results of GO functional enrichment analysis showed that DEGs were mainly enriched in the biological process(BP),such as chemical stimuli involved in sensory perception,Cajal body,and endopeptidase inhibitor activity.The results of KEGG pathway analysis showed that DEGs were mainly enriched in the pathway of Staphylococcus aureus infection and the pathway of maturity onset diabetes of the young.GSEA analysis showed that DEGs were mainly enriched in the Notch signaling pathway,the retinoic acid-inducible gene-Ⅰ(RIG-Ⅰ)-like receptor signaling pathway,the cytoplasmic DNA screening pathway,the base excision repair signaling pathway,natural killer(NK)cell-mediated cytotoxicity signaling pathway and T cell receptor signaling pathway.The results of immune infiltration analysis indicated that the expression of PRKD2 was positively correlated with five types of cells,such as activated dendritic cells(aDC),NK CD56dim cells and central memory T cells(Tcm)(P＜0.05),and negatively correlated with three types of immune cells,including macrophages,effector memory T cells(Tem)and plasmacytoid dendritic cells(pDC)(P＜0.05).The clinical characteristic subgroup analysis results showed that the expression levels of PRKD2 mRNA in BLCA patients who were over 70 years old and developed lymphovascular invasion were decreased(P＜0.05);the overall survival(OS),disease-specific survival(DSS)and progression-free interval(PFI)in the BLCA patients with PRKD2 high expression were significantly longer than those with PRKD2 low expression(P＜0.05).The univariate and multivariate Cox analyses indicated that distant metastasis,primary therapy outcome and clinicopathologic stage were the important factors affecting BLCA prognosis.About 9％patients had PRKD2 gene mutations,including missense mutation,gene amplification,mRNA low or high expression,and multi-motif mutation.The immunohistochemistry results showed that the expression level of IL-17F protein in BLCA tissue was significantly higher than that in cystitis tissue(P＜0.05).Conclusion:The expression level of PRKD2 in BLCA tissue is obviously increased,which could up-regulate the expression of IL-17F protein,and the decrease of PRKD2 protein expression may be a potential factor for the poor prognosis of BLCA patients.

Objective To investigate the effect of progressive muscle relaxation training intervention strategy in relieving fatigue of elderly patients with primary hepatocellular carcinoma(HCC)after receiving transcatheter arterial chemoembolization(T ACE),and to analyze its influencing factors.Methods Using convenience sampling method,a total of 150 elderly patients with HCC,who received TACE at a certain grade Ⅲ-A hospital at Peking of China from May 2021 to March 2023,were selected as the subjects of research.The patients were randomly divided into the study group and the control group,and progressive muscle relaxation training intervention strategy and conventional postoperative fatigue care method were employed respectively.The preoperative fatigue status and the postoperative fatigue recovery status were compared between the two groups,and the influencing factors were analyzed.Results In both groups,the postoperative one-day fatigue score was the highest,which was gradually decreased thereafter.The average recovery time of fatigue in the control group was 9.84 days,which in the study group was 6.16 days,the difference between the two groups was statistically significant(P=0.013).The body mass index(BMI),Child-Pugh classification,and preoperative grip strength index had an effect on the postoperative fatigue recovery time after intervention.A BMI of β=-0.953 and a preoperative grip strength index of β=-0.185 were negatively correlated with the postoperative fatigue recovery time after intervention,while a Child-Pugh classification of β=2.177 was positively correlated with the postoperative fatigue recovery time after intervention.Conclusion Progressive muscle relaxation training intervention strategy is helpful for shortening the postoperative fatigue recovery time in elderly patients with HCC after receiving TACE,and it is worth of promotion in clinical practice.The patient's nutrition and physical status such as BMI,hepatic reserve function and grip strength index,are the factors influencing the effectiveness of progressive muscle relaxation training intervention strategy.

Objective:To explore the adaptation process of the caregiving role of parents of children with autism spectrum disorder(ASD), and provide reference for targeted intervention strategies.Methods:Using purposive sampling, parents of children with ASD from the Pediatric Rehabilitation Center of Yangzhi Rehabilitation Hospital affiliated with Tongji University (Shanghai Sunshine Rehabilitation Center) were selected as study participants from October 2023 to May 2024.A qualitative research approach employing interpretative phenomenological analysis was adopted, with interviews conducted among 8 parents of children with ASD. Interview data were recorded, transcribed, and analyzed according to interpretative phenomenological analysis.Results:A total of 8 parents of children with ASD were interviewed, including 1 father and 7 mothers, aged 35-45 years. The process of stigma acceptance among parents of children with ASD as caregivers could be summarized into four themes: the acceptance journey of disease diagnosis; family responses to the impact of the disease; integration strategies across different living spaces; and mutual growth with the child through companionship and care.Conclusions:The diagnosis of ASD triggers intense emotional reactions in parents and leads to changes in family relationships and role functions. Collaborative efforts among healthcare institutions, schools, and community systems are necessary to empower parents of children with ASD, facilitating their adaptation to caregiving roles, enhancing their caregiving capabilities, and ultimately supporting better social integration for children with ASD.

Objective:To explore the adaptation process of the caregiving role of parents of children with autism spectrum disorder(ASD), and provide reference for targeted intervention strategies.Methods:Using purposive sampling, parents of children with ASD from the Pediatric Rehabilitation Center of Yangzhi Rehabilitation Hospital affiliated with Tongji University (Shanghai Sunshine Rehabilitation Center) were selected as study participants from October 2023 to May 2024.A qualitative research approach employing interpretative phenomenological analysis was adopted, with interviews conducted among 8 parents of children with ASD. Interview data were recorded, transcribed, and analyzed according to interpretative phenomenological analysis.Results:A total of 8 parents of children with ASD were interviewed, including 1 father and 7 mothers, aged 35-45 years. The process of stigma acceptance among parents of children with ASD as caregivers could be summarized into four themes: the acceptance journey of disease diagnosis; family responses to the impact of the disease; integration strategies across different living spaces; and mutual growth with the child through companionship and care.Conclusions:The diagnosis of ASD triggers intense emotional reactions in parents and leads to changes in family relationships and role functions. Collaborative efforts among healthcare institutions, schools, and community systems are necessary to empower parents of children with ASD, facilitating their adaptation to caregiving roles, enhancing their caregiving capabilities, and ultimately supporting better social integration for children with ASD.

Objective:To explore the value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic live failure (COSSH-ACLF Ⅱ) score combined with serum alpha-fetoprotein (AFP) in predicting the prognosis of hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients treated with artificial liver therapy.Methods:A total of 174 HBV-ACLF patients who underwent initial artificial liver therapy admitted to the Department of Infectious Diseases, The First Hospital of Shanxi Medical University, from March 2023 to April 2024 were enrolled. The model for end-stage liver disease (MELD), MELD combined with serum sodium (MELD-Na), MELD 3.0, and COSSH-ACLF Ⅱ scores were calculated. The 174 patients were divided into a training set and a validation set at a 7∶3 ratio. Based on follow-up survival outcomes, the patients in the training and validation sets were classified into survival and non-survivor groups. Laboratory tests, serum AFP levels, and various model scores were compared between the two groups. Logistic regression analysis was used to identify prognostic factors in HBV-ACLF patients, and a nomogram model was constructed. The predictive value of COSSH-ACLF Ⅱ score combined with serum AFP levels for follow-up deadline (June 14, 2024) prognosis and survival outcomes at 30, 60, and 90 days post-artificial liver therapy in HBV-ACLF patients was assessed using receiver operating characteristic (ROC) curves. Statistical comparisons were performed using the independent sample t test and Mann-Whitney U test. Results:Among the 174 HBV-ACLF patients, 122 were in the training set (80 survivors, 42 non-survivors) and 52 were in the validation set (17 survivors, 35 non-survivors). In the training set, age, neutrophil count, urea, MELD score, MELD-Na score, MELD 3.0 score, COSSH-ACLF Ⅱ score, and AFP levels in the non-survivor group were significantly higher than those in the survivor group ( t=2.82, Z=-3.27, Z=-2.65, t=2.16, t=2.60, t=2.33, t=4.56 and Z=-4.71, respectively, all P<0.05). In the validation set, albumin, COSSH-ACLF Ⅱ score, and AFP levels in the non-survivor group were significantly higher than those in the survivor group ( Z=-2.20, t=2.78 and Z=-2.55, respectively, all P<0.05). Serum AFP (odds ratio ( OR)=1.005, 95% confidence interval (95% CI) 1.001 to 1.008, P=0.010) and COSSH-ACLF Ⅱ score ( OR=2.140, 95% CI 1.410 to 3.240, P<0.001) were independent risk factors for the prognosis of HBV-ACLF patients. A nomogram predicting the prognosis of HBV-ACLF patients was constructed using serum AFP and the COSSH-ACLF Ⅱ score, with a C-index of 0.816 and a well-fitted calibration curve. In the training set, the areas under the curve (AUC) for COSSH-ACLF Ⅱ score, serum AFP levels, and their combined prediction of prognosis were 0.737, 0.760 and 0.816, respectively, and the AUCs for COSSH-ACLF Ⅱ score combined with serum AFP were 0.805, 0.797 and 0.739, respectively, for predicting the prognosis at 30, 60, and 90 days post-artificial liver therapy. In the validation set, the AUCs for COSSH-ACLF Ⅱ score, serum AFP levels, and their combined prediction of prognosis were 0.701, 0.720 and 0.785, respectively, and the AUCs for COSSH-ACLF Ⅱ score combined with serum AFP were 0.729, 0.684 and 0.624, respectively, for predicting prognosis at 30, 60, and 90 days post-artificial liver therapy. Conclusions:Serum AFP and the COSSH-ACLF Ⅱ score are independent risk factors for the prognosis of HBV-ACLF patients. Patients with poor prognosis may have higher COSSH-ACLF Ⅱ scores and serum AFP levels, and the combination of COSSH-ACLF Ⅱ score with serum AFP levels can improve the accuracy of predicting short-term prognosis in these patients.

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.