AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People's Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study. Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality. Further stratification was performed according to preoperative deviation angles [>35 prism diopters(PD)vs ≤35 PD] and age(≥18 years adult group vs <18 years adolescent group). The baseline patient characteristics were collected, deviation angles at multiple timepoints before and after treatment were measured, and stereopsis test results were documented. Through comparative analysis of therapeutic outcomes across subgroups, we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included. At the final follow-up, both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001). Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05). For patients with deviations >35 PD, surgery yielded significantly better outcomes than injection therapy in postoperative angle, success rate, and stereopsis recovery(P<0.05). Similarly, in patients aged ≥18 years, surgical treatment was superior to injections in reducing strabismus angle, improving success rates, and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE. Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy, particularly in patients with deviations >35 PD and those aged ≥18 years. For patients with angles ≤35 PD or under 18 years, BTXA injection remains a viable treatment option.

Objective:To investigate whether exosomes derived from atorvastatin (ATV)-pretreated human umbilical cord mesenchymal stem cells (ATV-MSC-EXO) alleviate high glucose-induced injury in human retinal vascular endothelial cells (HREC) via the protein kinase B (AKT)/endothelial nitric oxide synthase (eNOS) signaling pathway.Methods:The optimal pretreatment concentration of ATV was determined using the cell counting Kit-8 (CCK-8) assay. Exosomes derived from mesenchymal stem cells (MSC-EXO) and ATV-pretreated MSC (ATV-MSC-EXO) were isolated and extracted, and their morphology and surface markers were characterized by transmission electron microscopy, nanoparticle tracking analysis, and Western blotting (WB). The uptake capacity of exosomes by human retinal vascular endothelial cells (HREC) was evaluated using a fluorescence labeling assay. In vitro cultured HREC were divided into the following groups: normal control group (NC group), high glucose group (HG group), high glucose+MSC-EXO group (MSC-EXO group), high glucose+ATV-MSC-EXO group (ATV-MSC-EXO group), high glucose+ATV-MSC-EXO+AKT inhibitor group (ATV-MSC-EXO-MK-2206-2HCL group), and high glucose+ATV-MSC-EXO+eNOS inhibitor group (ATV-MSC-EXO-L-NAME group). Cell proliferation and apoptosis were detected using CCK-8 and flow cytometry, respectively. The protein expression levels of B-cell lymphoma/leukemia-2 (Bcl-2), Bcl-2-associated protein (Bax), and Caspase-3 were measured by WB. In addition, the regulatory effects of ATV-MSC-EXO on the AKT/eNOS signaling pathway and its downstream functional molecules were analyzed by detecting the phosphorylation levels of AKT (P-AKT/AKT) and eNOS (P-eNOS/eNOS) via WB, the mRNA expression levels of AKT and eNOS by quantitative real-time polymerase chain reaction, and the concentrations of nitric oxide (NO) and endothelin-1 (ET-1) using commercial NO and ET-1 assay kits.Results:The optimal pretreatment concentration of ATV was 1 μmol/L. ATV-MSC-EXO exhibited similar morphology and particle size to MSC-EXO and were efficiently taken up by HREC. Under high glucose conditions, ATV-MSC-EXO significantly enhanced the viability of HREC ( F=83.24, P<0.000 1) and inhibited apoptosis ( F=77.39, P<0.000 1). WB analysis further confirmed that ATV-MSC-EXO upregulated the expression of the anti-apoptotic protein Bcl-2 ( F=53.17), while downregulating the pro-apoptotic proteins Bax ( F=36.49) and Caspase-3 ( F=60.75) ( P<0.001). In addition, ATV-MSC-EXO markedly increased the protein levels of P-AKT/AKT ( F=107.60) and P-eNOS/eNOS ( F=38.59), as well as the relative mRNA expression of AKT, eNOS ( F=203.60, 315.00; P<0.000 1). Furthermore, ATV-MSC-EXO promoted NO production ( F=407.40) and suppressed the relative expression of ET-1 ( F=49.76) ( P<0.000 1). Conclusion:ATV-MSC-EXO enhances the viability and inhibits apoptosis of HREC under high glucose conditions by activating the AKT/eNOS signaling pathway.

This study elaborates on the teaching reform of the "Five-year Traditional Chinese Medicine Talent Training Program for Traditional Chinese Medicine (Orthopedics Direction)" implemented by Department of Orthopedics in Guangzhou University of Chinese Medicine, including curriculum reform (restructuring courses, emphasizing Lingnan characteristics, and combining medical sciences with martial arts) and teaching model reform (increasing mentorship and learning from teachers, arranging one mentor for every two students, and assigning one teaching team leader for every 5-6 groups). A questionnaire survey conducted among the students of the classes 2022 and 2023 in the five-year TCM talent training program for traditional Chinese medicine (TCM) majors (orthopedics direction) showed that 86.25% (69/80) of the students were satisfied with the mentorship model of "arranging one mentor for every two students", and 87.50% (70/80) of the students agreed that "the assignment of a teaching team leader can help to control teaching intensity". In terms of restructuring the curriculum system, 90.00% (72/80) of the students believed that the establishment of characteristic teaching courses could help to stimulate the enthusiasm for exploring TCM sciences, and 88.75% (71/80) of the students recognized the unique integration of textbooks, believing that it could help to understand the Lingnan school of Orthopedics. In terms of professional qualities, 90.00% (72/80) of the students agreed that the learning model of "systematic education+learning from teachers" could significantly help with the integration of knowledge, and 88.75% (71/80) of the students suggested that this model could stimulate the interest in specialized knowledge fields and motivate students to learn independently. In terms of apprenticeships with teachers, 85.00% (68/80) of the students reported that they could receive answers from teachers when asking questions, and 93.75% (75/80) of the students believed that early apprenticeship with a teacher was necessary. Some students still had a lack of understanding of learning TCM Qigong methods and believed that continuous practice took up too much personal time, failing to cultivate a good thinking of "the combination of medical sciences and martial arts", and they also believed that there were still limited opportunities for practice. The results show that the teaching model of "systematic education+learning from teachers" helps to improve the degree of satisfaction among students and cultivate clinical skills and professional qualities.

This study elaborates on the teaching reform of the "Five-year Traditional Chinese Medicine Talent Training Program for Traditional Chinese Medicine (Orthopedics Direction)" implemented by Department of Orthopedics in Guangzhou University of Chinese Medicine, including curriculum reform (restructuring courses, emphasizing Lingnan characteristics, and combining medical sciences with martial arts) and teaching model reform (increasing mentorship and learning from teachers, arranging one mentor for every two students, and assigning one teaching team leader for every 5-6 groups). A questionnaire survey conducted among the students of the classes 2022 and 2023 in the five-year TCM talent training program for traditional Chinese medicine (TCM) majors (orthopedics direction) showed that 86.25% (69/80) of the students were satisfied with the mentorship model of "arranging one mentor for every two students", and 87.50% (70/80) of the students agreed that "the assignment of a teaching team leader can help to control teaching intensity". In terms of restructuring the curriculum system, 90.00% (72/80) of the students believed that the establishment of characteristic teaching courses could help to stimulate the enthusiasm for exploring TCM sciences, and 88.75% (71/80) of the students recognized the unique integration of textbooks, believing that it could help to understand the Lingnan school of Orthopedics. In terms of professional qualities, 90.00% (72/80) of the students agreed that the learning model of "systematic education+learning from teachers" could significantly help with the integration of knowledge, and 88.75% (71/80) of the students suggested that this model could stimulate the interest in specialized knowledge fields and motivate students to learn independently. In terms of apprenticeships with teachers, 85.00% (68/80) of the students reported that they could receive answers from teachers when asking questions, and 93.75% (75/80) of the students believed that early apprenticeship with a teacher was necessary. Some students still had a lack of understanding of learning TCM Qigong methods and believed that continuous practice took up too much personal time, failing to cultivate a good thinking of "the combination of medical sciences and martial arts", and they also believed that there were still limited opportunities for practice. The results show that the teaching model of "systematic education+learning from teachers" helps to improve the degree of satisfaction among students and cultivate clinical skills and professional qualities.

Objective:To investigate whether exosomes derived from atorvastatin (ATV)-pretreated human umbilical cord mesenchymal stem cells (ATV-MSC-EXO) alleviate high glucose-induced injury in human retinal vascular endothelial cells (HREC) via the protein kinase B (AKT)/endothelial nitric oxide synthase (eNOS) signaling pathway.Methods:The optimal pretreatment concentration of ATV was determined using the cell counting Kit-8 (CCK-8) assay. Exosomes derived from mesenchymal stem cells (MSC-EXO) and ATV-pretreated MSC (ATV-MSC-EXO) were isolated and extracted, and their morphology and surface markers were characterized by transmission electron microscopy, nanoparticle tracking analysis, and Western blotting (WB). The uptake capacity of exosomes by human retinal vascular endothelial cells (HREC) was evaluated using a fluorescence labeling assay. In vitro cultured HREC were divided into the following groups: normal control group (NC group), high glucose group (HG group), high glucose+MSC-EXO group (MSC-EXO group), high glucose+ATV-MSC-EXO group (ATV-MSC-EXO group), high glucose+ATV-MSC-EXO+AKT inhibitor group (ATV-MSC-EXO-MK-2206-2HCL group), and high glucose+ATV-MSC-EXO+eNOS inhibitor group (ATV-MSC-EXO-L-NAME group). Cell proliferation and apoptosis were detected using CCK-8 and flow cytometry, respectively. The protein expression levels of B-cell lymphoma/leukemia-2 (Bcl-2), Bcl-2-associated protein (Bax), and Caspase-3 were measured by WB. In addition, the regulatory effects of ATV-MSC-EXO on the AKT/eNOS signaling pathway and its downstream functional molecules were analyzed by detecting the phosphorylation levels of AKT (P-AKT/AKT) and eNOS (P-eNOS/eNOS) via WB, the mRNA expression levels of AKT and eNOS by quantitative real-time polymerase chain reaction, and the concentrations of nitric oxide (NO) and endothelin-1 (ET-1) using commercial NO and ET-1 assay kits.Results:The optimal pretreatment concentration of ATV was 1 μmol/L. ATV-MSC-EXO exhibited similar morphology and particle size to MSC-EXO and were efficiently taken up by HREC. Under high glucose conditions, ATV-MSC-EXO significantly enhanced the viability of HREC ( F=83.24, P<0.000 1) and inhibited apoptosis ( F=77.39, P<0.000 1). WB analysis further confirmed that ATV-MSC-EXO upregulated the expression of the anti-apoptotic protein Bcl-2 ( F=53.17), while downregulating the pro-apoptotic proteins Bax ( F=36.49) and Caspase-3 ( F=60.75) ( P<0.001). In addition, ATV-MSC-EXO markedly increased the protein levels of P-AKT/AKT ( F=107.60) and P-eNOS/eNOS ( F=38.59), as well as the relative mRNA expression of AKT, eNOS ( F=203.60, 315.00; P<0.000 1). Furthermore, ATV-MSC-EXO promoted NO production ( F=407.40) and suppressed the relative expression of ET-1 ( F=49.76) ( P<0.000 1). Conclusion:ATV-MSC-EXO enhances the viability and inhibits apoptosis of HREC under high glucose conditions by activating the AKT/eNOS signaling pathway.

Brain is one of the most common metastatic sites for lung cancer,and brain metastases seriously affect the clinical prognosis of patients with non-small cell lung cancer(NSCLC).In the era of targeted therapy,a series of tyrosine kinase inhibitors(TKIs)have brought significant survival benefits to patients with NSCLC.However,this has also led to an increasing number of long-term survivors experiencing brain metastases.As a traditional treatment of brain metastases,radiotherapy can effectively control intracranial symptoms and improve the clinical condition of patients.In recent years,with the increased penetration of TKIs into the central nervous system,the intracranial control of NSCLC patients with brain metastases receiving TKI treatment has significantly improved,and the role of radiotherapy in patients with brain metastases has been gradually challenged.Therefore,how to rationally choose TKIs and radiotherapy to treat NSCLC brain metastases has become an important issue that needs to be addressed urgently.

Brain is one of the most common metastatic sites for lung cancer,and brain metastases seriously affect the clinical prognosis of patients with non-small cell lung cancer(NSCLC).In the era of targeted therapy,a series of tyrosine kinase inhibitors(TKIs)have brought significant survival benefits to patients with NSCLC.However,this has also led to an increasing number of long-term survivors experiencing brain metastases.As a traditional treatment of brain metastases,radiotherapy can effectively control intracranial symptoms and improve the clinical condition of patients.In recent years,with the increased penetration of TKIs into the central nervous system,the intracranial control of NSCLC patients with brain metastases receiving TKI treatment has significantly improved,and the role of radiotherapy in patients with brain metastases has been gradually challenged.Therefore,how to rationally choose TKIs and radiotherapy to treat NSCLC brain metastases has become an important issue that needs to be addressed urgently.

Objective:To observe the clinical and multimodal imaging characteristics of eyes with acute macular neuroretinopathy (AMN) associated with COVID-19.Methods:A retrospective clinical study. From December 18 to 26, 2022, 16 eyes of 8 patients with AMN associated with COVID-19 were included in the study. There were 4 males and 4 females; all cases were bilateral. The age was (31.5±9.6) years old. The time from fever to decreased vision was (3.75±1.04) days. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundus microscopy, fundus color photography, and optical coherence tomography (OCT) were performed in all patients. Infrared fundus photography (IR), OCT angiography (OCTA) and fluorescein fundus angiography (FFA) were performed in 14, 6 and 4 eyes respectively. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistics. The clinical data, IR, OCT and OCTA imaging features of the patients were retrospectively analyzed.Results:The logMAR BCVA of AMN eyes was 4.21±0.74, intraocular pressure was (14.87±1.50) mm Hg (1 mm Hg=0.133 kPa). Fundus color photography showed that multiple gray-white petal-shaped lesions were arranged around the macular fovea in 2 eyes; no obvious abnormality was found in the macular area in 14 eyes. Of the 14 eyes examined by IR, 6 eyes had irregular weak reflective lesions around the macular fovea. OCT showed strong reflex in the outer nuclear layer and outer plexiform layer of all eyes, including 15 eyes with elliptical zone injury. In 6 eyes examined by OCTA, the blood flow density of the superficial and deep capillary plexus (DCP) of retina decreased, and the blood flow density of DCP decreased significantly. The en-face image of DCP showed the wedge-shaped strong reflective lesion area with the tip pointing to the central fovea in 2 eyes. No abnormal fluorescence was observed in FFA.Conclusions:The characteristic manifestation of AMN associated with COVID-19 is weak reflex focus in IR; OCT shows strong reflection in outer core layer and outer plexiform layer; OCTA showed that retinal DCP blood flow density decreased.

Objective:To explore the impact of preoperative Naples prognostic score (NPS) on the survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC).Methods:From December 2014 to December 2020, a total of 134 patients who underwent radical esophagectomy in Department of Thoracic Surgery, Affiliated Taixing People′s Hospital of Yangzhou University were retrospectively analyzed. The NPS was calculated by the median values of preoperative serum albumin, total cholesterol, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR), and then the enrolled patients were divided into NPS 0 group (20 cases), NPS 1 or 2 group (62 cases) and NPS 3 or 4 group (52 cases). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univa-riate and multivariate Cox models were used to analyze the relationship between NPS and survival prognosis.Results:The 1-, 3- and 5-year progression free survival (PFS) rates were 95.0%, 70.0% and 60.0% in the NPS 0 group, 66.1%, 24.2% and 24.2% in the NPS 1 or 2 group, and 48.1%, 3.8% and 1.9% in the NPS 3 or 4 group respectively, with a statistically significant difference ( χ2=31.27, P<0.001). In the NPS 0 group, the 1-, 3- and 5-year overall survival (OS) rates were 100.0%, 80.0% and 70.0% respectively. In the NPS 1 or 2 group, the 1-, 3- and 5-year OS rates were 96.8%, 36.7% and 32.3% respectively, while in the NPS 3 or 4 group, the 1-, 3- and 5-year OS rates were 90.4%, 32.7% and 5.8% respectively, and there was a statistically significant difference ( χ2=29.70, P<0.001). Univariate analysis found that sex, T stage, N stage, TNM stage and NPS were closely related to PFS and OS of patients with thoracic ESCC (all P<0.05). Furthermore, multivariate Cox regression analysis showed that T stage ( HR=1.46, 95% CI: 1.07-2.00, P=0.019), N stage ( HR=1.34, 95% CI: 1.02-1.76, P=0.037) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.35, 95% CI: 1.58-7.11, P=0.002; NPS 3 or 4 group: HR=6.15, 95% CI: 2.89-13.11, P=0.001) were independent prognostic factors for PFS. Additionally, T stage ( HR=1.67, 95% CI: 1.01-2.77, P=0.046), N stage ( HR=1.44, 95% CI: 1.00-2.20, P=0.048) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.10, 95% CI: 1.31-7.32, P=0.010; NPS 3 or 4 group: HR=5.09, 95% CI: 2.14-12.11, P=0.001) were independent prognostic factors for OS. Conclusion:Preoperative NPS plays an important role in predicting the survival prognosis of patients with thoracic ESCC.

Objective:To investigate the effects of pre-treatment Naples prognostic score (NPS), including inflammation-related and nutrition-related indicators, on the treatment efficacy and prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving chemoradiotherapy.Methods:A retrospective analysis was conducted for 123 patients diagnosed with thoracic ESCC. These patients were treated either with standard curative radiotherapy (RT) alone or with concurrent chemoradiotherapy (CCRT) in the Affiliated Taixing People's Hospital of Yangzhou University between January 2014 and December 2017. The patients were divided into NPS 0 group (18 cases), NPS 1 or 2 group (60 cases), and NPS 3 or 4 group (45 cases). The responsiveness to treatment was analyzed using logistic regression analysis. The Kaplan-Meier method and log-rank test were adopted to calculate and compare the progression-free survival (PFS) and overall survival (OS) rates. Meanwhile, Cox proportional hazards models were used for the multivariate analyses.Results:The overall effective rate across the entire cohort was 65.0%, and the effective rates of the NPS 0 group, NPS 1 or 2 group, and NPS 3 or 4 group were 88.9%, 73.3%, and 44.4%, respectively. As indicated by the univariate logistic analysis, the treatment responses in patients with ESCC were highly associated with TNM stage, treatment method, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and NPS (1 or 2 group and 3 or 4 group) ( HR =1.633, 0.225, 4.002, 0.320, 2.909, 6.591, P<0.05). Subsequently, multivariate logistic regression analysis showed that treatment strategy alone ( HR =0.214, 95% CI 0.105-0.436, P=0.001), NLR ( HR =2.547, 95% CI 1.248-5.199, P=0.010), and NPS (1 or 2 group: HR=1.193, 95% CI 1.377-9.691, P=0.033; 3 or 4 group: HR =3.349, 95% CI 1.548-10.499, P=0.003) were independent risk factors for tumour response. In addition, the univariate analysis indicates that TNM stage, treatment modality, NLR, LMR, and NPS were significantly associated with PFS and OS( HRPFS=1.480, 0.364, 2.129, 0.635, 3.316, 6.599, P < 0.05; HROS=1.149, 0.308, 2.306, 0.609, 3.316, 6.599, P < 0.05). Furthermore, multivariate Cox proportional hazard regression model analysis showed that TNM stage ( HR =1.408, 95% CI 1.069-1.854, P=0.015), treatment modality ( HR =0.367, 95% CI 0.261-0.516, P=0.015), NLR ( HR =1.518, 95% CI 1.078-2.139, P=0.017), and NPS (1 or 2 group: HR=3.279, 95% CI 1.405-7.653, P=0.006; 3 or 4 group: HR =6.233, 95% CI 2.439-15.875, P < 0.001) were considered independent prognostic factors for PFS. Additionally, these parameters were also independent prognostic factors for OS. Conclusions:Using inflammation-related and nutrition-related biomarkers, this study demonstrated that NPS is promising as a predictive indicator for the therapeutic effects and survival prognosis in patients with ESCC receiving CRT or RT alone.