AIM: To explore the effect of Kappa angle on changes in visual quality and stereoscopic acuity after regional refractive multifocal intraocular lens(MIOL)implantation in patients with high myopia complicated by cataract.METHODS:A retrospective analysis was conducted on data from patients with normal Kappa angle and high myopia complicated by cataract treated at the hospital from January 2024 to January 2025. Patients were divided into two groups based on the median preoperative Kappa angle(0.182 mm): Group A(00.05). The actual residual astigmatism in Group A was lower than that in Group B at 7 d, 1 and 3 mo postoperatively(all P<0.001). The proportion of eyes with near stereoscopic acuity <60″ was higher in Group A than in Group B, while the proportion of eyes with near stereoscopic acuity between 400″ and 3000″ was lower in Group A than in Group B(both P<0.05). Meanwhile, the incidence of visual disturbances in Group B was higher than that in Group A(P<0.05).CONCLUSION: The Kappa angle has no significant effect on visual acuity or objective visual quality in patients with normal Kappa angle and high myopia complicated by cataract after regional refractive MIOL implantation. However, patients with a larger Kappa angle exhibit higher postoperative residual astigmatism, worse near stereoscopic acuity, and a higher incidence of vision-related adverse symptoms.

A traditional Chinese medicine(TCM)monomer is a bioactive compound extracted from Chinese herbal medicines possessing determined biological activity and pharmacological effects,and has gained much attention for treating neuronal diseases.However,the application of TCM monomers is limited by their low solubility and poor ability to cross the blood-brain barrier(BBB).Exosomes are small extracellular vesicles(EVs)ranging in size from 30 to 150 nm in diameter and can be used as drug delivery carriers that directly target cells or tissues with unique advantages,including low toxicity,low immunogenicity,high stability in blood,and the ability to cross the BBB.This review discusses the biogenesis,components,stability,surface modification,isolation technology,advantages,and disadvantages of exosomes as drug carriers and compares exosomes and other similar drug delivery systems.Furthermore,exosome-encapsulated TCM monomers exert neuroprotective roles,such as anti-inflammation,anti-apoptosis,anti-mitophagy,and anti-oxidation,in various neuronal diseases,including Alzheimer's disease(AD),Parkinson's disease(PD),multiple sclerosis(MS),and cerebral ischemia and reperfusion(CI/R)injury,as well as anti-drug resistance,anti-tumorigenesis,anti-angiogenesis,and promotion of apoptosis in brain tumors,providing more inspiration to promote the development of an exosome-based delivery tool in targeted therapy for neuronal diseases.

Objective:To investigate the effect of mindfulness-based cognitive therapy on the sense of personal control and illness perception of young and middle-aged patients after percutaneous coronary intervention (PCI), so as to provide theoretical and practical guidance for the psychological care of patients after PCI.Methods:A randomized controlled trial was conducted. From January 2022 to December 2023, young and middle-aged patients after PCI admitted to the Department of Cardiology, Qinhuai Medical District, Eastern Theater Command General Hospital of the Chinese People′s Liberation Army were selected as the research subjects by convenient sampling method, patients were divided into the experimental group and the control group by the random number table method. The control group was given routine nursing, and the experimental group was given mindfulness-based cognitive therapy on the basis of routine nursing. The Personal Mastery Scale (PMS), Cardiac Self-Efficacy Questionnaire (CSEQ), and Brief Illness Perception Questionnaire (BIPQ) were used to evaluate personal sense of control, self-efficacy, and illness perception before and after the intervention respectively.Results:A total of 80 young and middle-aged patients after PCI were included. There were 40 cases in the control group, including 25 males and 15 females, aged (49.43 ± 5.55) years old. There were 40 cases in the experimental group, including 19 males and 21 females, aged (49.03 ± 4.19) years old. Before the intervention, there was no statistically significant difference in the PMS, CSEQ and BIPQ scores between the two groups of patients (all P>0.05). After the intervention, the PMS, CSEQ scores of the patients in the experimental group were (23.03 ± 2.54), (45.85 ± 8.16) points respectively, which were higher than (21.95 ± 2.28), (39.05 ± 8.78) points in the control group, the BIPQ score of the patients in the experimental group was(39.63 ± 8.12) points, which was lower the (45.45 ± 8.64) points in the control group, the differences were statistically significant ( t=-2.00, -3.59, 3.11, all P<0.05). Conclusions:Mindfulness-based cognitive therapy can effectively improve the sense of personal control and self-efficacy of young and middle-aged patients after PCI, reduce the sense of threat to the disease.

Objective:The prediction model of postoperative recurrence of ovarian endometriosis cyst(OEM)was constructed to provide a reference for evaluating postoperative recurrence of OEM patients.Methods:The clinical,pathological and follow-up data of 342 patients who underwent the initial laparoscopic ovarian cystectomy for OEM at The Second Hospital of Hebei Medical University from January 1,2017 to October 31,2021 were retro-spectively analyzed.Based on univariate and multivariate Cox regression analysis,the relevant factors affecting OEM recurrence were identified.According to the results of multivariate analysis,a nomogram was drawn.The C index and receiver operating characteristic(ROC)curve were used to test the efficiency of the prediction model.Results:The 2-year recurrence rate of OEM patients was 20.4%and the 5-year recurrence rate was 35.2%.Uni-variate and multivariate Cox regression analysis showed that menstrual cycle(HR 0.916,95%CI 0.860-0.976,P=0.006),delivery≥1(HR 0.376,95%CI 0.171-0.827,P=0.015),CA125≥100 U/ml(HR 1.790,95%CI 1.167-2.746,P=0.008),total cyst diameter≥10 cm(HR 2.254,95%CI 1.318-3.854,P=0.003),and postoperative medications(HR 0.434,95%CI 0.292-0.644,P=0.000)were associated with OEM recurrence and were included in the no-mogram prediction model.The C-index of the nomogram prediction model was 0.710(95%CI 0.665-0.754),and the area under the curve(AUC)of the ROC for OEM patients with recurrence at 2 years after surgery was 0.786 and 0.708 at 5 years.Conclusions:In this study,we developed a nomogram to predict the probability of recur-rence at 2 years and 5 years for OEM patients under 45 years who underwent conservative surgery,which has i-deal predictive performance and helps clinicians to screen high-risk patients,and thus give high-risk OEM patients additional attention and intervention.

Objective:To investigate the influence of serum C-X-C motif chemokine ligand 9 (CXCL9) and C-X3-C motif chemokine ligand 1 (CX3CL1) on the development of preeclampsia in patients with gestational diabetes mellitus (GDM).Methods:A retrospective analysis was conducted on the clinical data of 398 GDM patients admitted to Huangshi Aikang Hospital from January 2021 to August 2024. Based on the occurrence of preeclampsia, patients were divided into the GDM-preeclampsia group (51 cases) and the simple GDM group (347 cases). The baseline data, blood glucose indicators, four lipid items, platelet count (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen, serum creatinine, and 24-hour urinary protein quantification were compared between the two groups. The influencing factors for GDM complicated by preeclampsia were analyzed, and the predictive value of serum CXCL9 and CX3CL1 for the onset of preeclampsia in GDM patients was assessed. Measurement data with a normal distribution were expressed as Mean ± SD, and the t'-test was used for intergroup comparisons when variances were unequal; measurement data with a skewed distribution were expressed as M ( Q1, Q3), and the Wilcoxon rank-sum test was used for intergroup comparisons; counting data were expressed as case (%), and the χ2 test was used for intergroup comparisons. Unconditional logistic regression models were used to analyze the risk factors for preeclampsia in GDM patients. The predictive value of serum CXCL9 and CX3CL1 levels for preeclampsia in GDM patients was analyzed using the receiver operator characteristic (ROC) curve. Results:Pre-pregnancy body mass index, glycated hemoglobin, and 24-hour urinary protein quantification in the GDM-preeclampsia group [(24.50±3.74) kg/m 2, (5.68±0.52)%, 0.42 (0.17, 0.69) g] were all higher than those in the simple GDM group [(22.70±2.97) kg/m 2, (5.42±0.44)%, 0.30 (0.10, 0.44) g], with statistically significant differences between groups (statistic values: t'=3.90, t'=3.85, U=2.70; P values: <0.001, <0.001, 0.007, respectively). Serum CXCL9 levels in the GDM-preeclampsia group [(111.69±36.65) ng/L] were lower than those in the simple GDM group [(200.16±85.57) ng/L], while CX3CL1 levels [(2.22±0.29) μg/L] were higher than those in the simple GDM group [(1.83±0.35) μg/L], with statistically significant differences ( t' values: 7.28 and 7.58, respectively; both P<0.001). Multivariate logistic regression analysis showed that increased CX3CL1 ( OR=1.562, 95% CI: 1.237-1.972), decreased CXCL9 ( OR=0.979, 95% CI: 0.970-0.989), increased pre-pregnancy body mass index ( OR=1.226, 95% CI: 1.060-1.417), and increased glycated hemoglobin ( OR=3.474, 95% CI: 1.192-10.122) were associated with an increased risk of developing preeclampsia in GDM patients ( P values: <0.001, <0.001, 0.006, 0.023, respectively). The ROC curve showed that the area under the curve for serum CXCL9 (sensitivity: 88.24%, specificity: 70.89%) and CX3CL1 (sensitivity: 78.43%, specificity: 69.16%) in predicting preeclampsia in GDM patients were both >0.50 ( P values: 0.015, 0.034, respectively), indicating that both have high predictive efficacy, with CXCL9 being slightly superior to CX3CL1. Conclusion:Decreased serum CXCL9 and increased CX3CL1 are associated with an increased risk of preeclampsia in GDM patients. Both can serve as auxiliary predictive indicators for preeclampsia in GDM patients.

To construct a recombinant fowl adenovirus 4(FAdV-4)expressing the Cap protein of goose astrovirus genotype 2(GoAstV-2),the expression cassette of Cap gene was inserted into the natural 1 966 bp deletion region of the FAdV-4 genome in the infectious clone p15A-cm-FAdV4-HNJZ.The resulted recombinant plasmid p15A-cm-FAdV4-HNJZ-Cap/GoAstV-2 was linearized with restriction enzyme and transfected into chicken hepatoma cell line(LMH)to rescue the recombinant FAdV-4 expressing the Cap protein of GoAstV-2,rF Ad V4-Cap/GoAstV-2.After 15 passages in LMH cells,the recombinant rFAdV4-Cap/GoAstV-2 was identified by PCR using primers flanking the insertion site of the Cap gene expression cassette and using viral genome DNA extracted from rFAdV4-Cap/GoAstV-2 infected LMH cells as template.LMH cells were in-fected with 15th passage rFAdV4-Cap/GoAstV-2 and indirect immunofluorescence was performed with a polyclonal antibody against Cap protein as the primary antibody.Western blot was carried out with lysates of rFAdV4-Cap/GoAstV-2 infected LMH cells.The in vitro replication dynamic of the 15th passage of the rFAdV4-Cap/GoAstV-2 was also investigated in LMH cells.The results demonstrated that the Cap gene of GoAstV-2 was presented in the genome of the recombinant vi-rus rF AdV4-Cap/Go Ast V-2,and could be expressed stably.The prepared recombinant virus in this study will lay a foundation for developing inactivated bivalent vaccine candidate against co-in-fection of FAdV-4 and GoAstV-2 in goose.

Objective:To analyze the co-morbidity patterns of chronic diseases among the elderly in China and provide suggestions for health management strategies.Methods:It was a cross-sectional study. A total of 9 383 respondents aged ≥60 years with complete data of key variables (chronic disease status, age, gender, marital status, etc.) in the 2020 China Health and Aged Care Tracking Survey (CHARLS) dataset were selected as study subjects. Systematic clustering was used to analyze the pattern of multimorbidity among urban and rural elderly, and probit model was used to analyze the relevant factors associated with the risk of multimorbidity in order to provide suggestions for health management strategies.Results:There were similarities in the multimorbidity patterns of chronic diseases among the elderly in both urban and rural areas in China, including emotional and mental problems, Parkinson′s disease and malignant tumors such as cancer as a group of psychosomatic and neurodegenerative disease pattern, and stroke, asthma and liver disease as a group of inflammatory response disease pattern. However, there were differences, with dyslipidemia clustered as a separate group among the urban elderly, and memory-related diseases with diabetes or elevated blood glucose, chronic lung disease and kidney disease clustered as another group; and in rural elderly, gastric or digestive disorders were clustered with memory-related disorders, diabetes or elevated blood glucose, chronic lung disease, and kidney disease. Registered residence in rural areas ( Z=-0.530), and heavy physical activity (Z=-0.024) were negatively with the risk of multimorbidity. Age ( Z=0.037), alcohol consumption ( Z=0.037), smoking ( Z=0.042), depression score ( Z=0.130), and length of sleep ( Z=0.027) were positively correlated with the risk of multimorbidity (all P<0.05), with domicile location being the most strongly associated factor, and depression score being the second one. Conclusion:The pattern of chronic disease co-morbidity among the elderly in China differs between urban and rural areas. It is recommended that targeted chronic disease management strategies should be developed based on the characteristics of chronic disease co-morbidity among the elderly in urban and rural areas in China to improve the effectiveness of chronic disease co-morbidity prevention and management.

Objective:To analyze the infection status and influencing factors of Helicobacter pylori ( Hp) in healthy children. Methods:This is a cross-sectional study. The data of 684 children aged 3 to 14 years who underwent the 13C urea breath test in the Health Management Center of Fuwai Central China Cardiovascular Hospital from December 2022 to December 2023 were retrospectively collected, and 652 of them who met the criteria were included in the analysis. According to whether they were infected with Hp, the children were divided into the infected group and the non-infected group, and the differences in age, gender, living habits and other aspects between the two groups were compared. Multivariate logistic regression analysis was used to analyze the factors influencing Hp infection. Results:Among the 652 children, there were 134 cases in the infected group and 518 cases in the non-infected group, with an Hp infection rate of 20.6%. The Hp infection rate showed an upward tendency with age. The Hp infection rates in children aged 3 to 5 years, 6 to 11 years, and 12 to 14 years were 12.6%, 22.0%, and 25.2% respectively ( χ 2=9.862, P=0.007). Univariate analysis showed that the proportions of Hp infection were higher in children who never washed their hands, ate in school cafeterias, did not have separate meals, were fed with chewed food, bit their fingers or toys, lived with relatives who had a history of gastrointestinal diseases, had low family income, had parents with low educational level, and were mixed/artificially fed during infancy, which were 26.1%, 24.1%, 25.4%, 25.7%, 26.0%, 25.8%, 25.1%, 23.7%, and 23.6% respectively (all P<0.05). Multivariate analysis showed that separate meals, good handwashing habits, and high family income were protective factors against Hp infection ( OR=0.689, 0.779, 0.602, P=0.004, 0.013, 0.019), while feeding with chewed food was a risk factor for Hp infection ( OR=1.998, P=0.001). Conclusion:The Hp infection rate of children undergoing health examination in Zhengzhou is at low level, and the main influencing factors are separate meals, handwashing habits, feeding with chewed food, and family income.

Objective:To investigate the trends in insulin resistance, as represented by the triglyceride-glucose index (TyG index), among Chinese adult residents from 2010 to 2018 and to explore influencing factors.Methods:China Chronic Disease and Risk Factor Surveillance was conducted in 2010, 2013, and 2018, using a multi-stage stratified cluster random sampling method across all 31 provinces (autonomous regions and municipalities) in China. This study sampled 98 712 adults in 2010, 176 534 adults in 2013, and 184 876 adults in 2018, all aged ≥18 years, totaling 406 933 participants. Individuals with a TyG index > P75 were classified as having insulin resistance. The mean TyG index and the prevalence of insulin resistance were calculated for different years, sexes, age groups, provinces (autonomous regions and municipalities), and subgroups for 2018. Linear and logistic regression models were used to test trends in means and rates over time, and multivariate logistic regression models were conducted to analyze potential factors associated with insulin resistance. All analyses were adjusted for complex sampling weights based on the study design. Results:From 2010 to 2018, the mean TyG index among Chinese adults increased from 8.44±0.63 to 8.70±0.64, with significant upward trends observed across different age groups, sexes, and urban-rural residencies (all P<0.001). The mean TyG index was higher among males, urban residents, and those aged 45-59. There were significant differences in the mean TyG indices and prevalence of insulin resistance across provinces (autonomous regions and municipalities) (all P<0.05). Higher insulin resistance prevalence was independently associated with being male, aged ≥45 years, living in urban areas, excessive alcohol consumption, and insufficient physical activity (all P<0.05). Conclusions:From 2010 to 2018, the level of insulin resistance, as indicated by the TyG index, showed an increasing trend among Chinese adults. Males, individuals aged ≥45 years, urban residents, and individuals with unhealthy lifestyles such as excessive alcohol consumption or insufficient physical activity should be the focus of efforts to prevent and control metabolic diseases related to insulin resistance.

Objective To explore the application of cell block(CB)technology in the diagnosis of papillary thyroid carcinoma(PTC).Methods A total of 86 patients with thyroid nodules who were treated at Luoyang Central Hospital Affiliated to Zhengzhou University from February 2023 to December 2024 were retrospectively selected.Before the operation,all patients underwent ultrasound-guided fine needle aspiration biopsy.After the biopsy,the specimens were respectively subjected to cell smear(CS)and CB pathological examinations.Using postoperative pathology as the gold standard,the clinical application value of CS,CB,BRAFV600E gene detection,and combined detection in the preoperative diagnosis of PTC was evaluated.Results A total of 86 patients were included.Among them,42 cases were diagnosed as PTC by postoperative pathology,and 44 cases were benign lesions.The sensitivity(73.81％),specificity(97.73％),positive predictive value(96.88％),negative predictive value(79.63％),and accuracy(86.05％)of CB in the preoperative diagnosis of PTC were significantly higher than those of CS.The Kappa consistency test results showed that the consistency between CB pathological results and postoperative pathological results was better than that of CS.Receiver operating characteristic curve analysis indicated that the area under the curve(AUC)of CB was significantly higher than that of CS(0.858 vs.0.743,Z=2.391,P=0.017).Furthermore,the combination of CB and BRAFV600E gene detection further improved preoperative diagnostic performance,with a consistency with postoperative pathological results(Kappa=0.837)superior to other examination methods,and an AUC(0.918)significantly higher than other examination methods.Conclusion CB has significant clinical application value in the preoperative diagnosis of PTC,with diagnostic performance significantly superior to CS.Further combination with BRAFV600E gene detection can significantly improve preoperative diagnostic accuracy.