Diabetic retinopathy(DR), the most common microvascular complication of diabetes, has become a leading cause of visual impairment and blindness across all age groups. The early diagnosis and severity assessment of DR rely on the precise evaluation of retinal microvascular alterations. The periarterial capillary-free zone(paCFZ), a physiological avascular region surrounding retinal arteries, has recently been recognized as an important biomarker reflecting the status of retinal microcirculation. Advances in optical coherence tomography angiography(OCTA)have enabled noninvasive, high-resolution quantification of the paCFZ, offering a novel approach for the early detection and stratification of DR. This review systematically summarizes the definition and developmental mechanism of the paCFZ, as well as its morphological characteristics across different stages of DR, with a particular focus on the advantages of OCTA in visualizing and quantifying the paCFZ. We further discuss the differential manifestations of the paCFZ in nonproliferative DR and proliferative DR, and its associations with retinal ischemia and oxygenation status. In addition, the potential clinical value of paCFZ in evaluating responses to anti-vascular endothelial growth factor(VEGF)therapy and predicting disease progression is summarized. Finally, the challenges in clinical translation and future research directions are addressed, aiming to provide theoretical support and new perspectives for early screening, risk stratification, and personalized management of DR.

Aim To evaluate the effect of hemoperfusion on carotid artery elasticity in patients undergoing hemo-dialysis using shear wave elastography(SWE).Methods Seventy-eight patients with uremia were included,and di-vided into two groups based on dialysis regimen:hemodialysis alone group and hemodialysis combined with hemoperfusion group,while 40 healthy subjects were selected as control group.Then general information,clinical data and biochemical indices were collected.The carotid intima-media thickness(IMT),carotid artery inner diameter at the end of systole(Ds),the carotid artery inner diameter at the end of diastole(Dd)and the peak systolic flow velocity(PSV)were meas-ured by conventional ultrasound.The degree of arterial wall motion(△D)and arterial stiffness coefficient(β)were cal-culated.Elasticity of intima-medial layer in the anterior carotid artery was measured by SWE,including the maximum modulus of elasticity(MEmax),mean modulus of elasticity(M Emean),minimum modulus of elasticity(MEmin).Re-sults There were no statistically significant differences in Ds,Dd,△D and PSV among the three groups(all P＞0.05).Compared with control group,the IMT,β,SWE parameters were significantly increased in the hemodialysis combined with hemoperfusion group and the hemodialysis alone group.Compared with hemodialysis alone group,the SWE parameters were significantly decreased in the hemodialysis combined with hemoperfusion group(P＜0.05),while there were no statis-tically significant differences in IMT and β(both P＞0.05).In the three groups,SWE parameters were positively correla-ted with IMT,β and LDLC(r＞0.37,all P＜0.01)and negatively correlated with HDLC(|r|＞0.24,all P＜0.05).The areas under the ROC curves of the SWE parameters were all higher than those of the conventional ultrasound parameters(all P＜0.05).Conclusion SWE can effectively assess the effect of hemoperfusion on the elasticity of carotid arteries in uremic patients undergoing hemodialysis.

Aim To evaluate the right atrial function by two-dimensional speckle tracking imaging(2D-STI)combined with real-time three-dimensional echocardiography(RT-3DE)in patients with triple vessel coronary artery disease(TVCAD)without myocardial infarction.Methods Fifty-six patients with TVCAD without myocardial infarc-tion were selected and divided into two groups according to the results of coronary angiography:28 cases with a stenosis rate of 50％～75％and 28 cases with a stenosis rate of ≥75％.In addition,30 healthy volunteers were screened as control group.RT-3DE was performed to obtain the parameters of right atrial volume(RAVmax,RAVmin and RAVp)and then calculated right atrial passive ejection fraction(RAPEF)and right atrial active ejection fraction(RAAEF),and the maxi-mum of right atrial volume index(RAVImax).2D-STI was applied to measure right atrium strain rates during systole,ear-ly diastole and late diastole(RASRs,RASRe and RASRa).Correlation between 2D-STI parameters and N-terminal pro-brain natriuretic peptide(NT-proBNP),Gensini scores were analyzed by Pearson analysis.ROC curve analysis was used to evaluate the diagnostic value of 2D-STI,RT-3DE,and their combined use for right atrial function in TVCAD patients without myocardial infarction.Results Compared with control group,RAPEF and RASRe reduced in stenosis rate of 50％～75％group,while RAAEF and RASRa increased(all P＜0.05).Compared with control group and stenosis rate of 50％～75％group,RAPEF,RASRs,RASRe and RASRa decreased,while RAVmax,RAVmin,RAVp,RAVImax and RAAEF increased in stenosis rate of ≥75％group(all P＜0.05).There was a significant correlation between 2D-STI pa-rameters and NT-proBNP and Gensini scores.The area under the curve of right atrial function in TVCAD patients without myocardial infarction was 0.9048,0.8917 and 0.9564 for 2D-STI,RT-3DE and their combined use,respectively.The diagnostic efficacy of the two methods was significantly higher when used in combination than when used alone,and 2D-STI was superior to RT-3DE.Conclusion When evaluating the right atrial function of TVCAD patients without myocardial infarction,the diagnostic efficacy of 2D-STI combined with RT-3DE is higher than that of using it alone,and 2D-STI is su-perior to RT-3DE.

Objective:To analyse the clinical characteristics of 214 cases of paediatric high altitude pulmonary edema（HAPE）and the efficacy of dexamethasone in adjunctive therapy.Methods:This retrospective study analyzed 214 pediatric cases of HAPE admitted to the Department of Paediatrics of the General Hospital of Tibetan Military between June 2015 to June 2017 and June 2019 to June 2021.Patients were divided into dexamethasone-treated group and dexamethasone-untreated group.Baseline data，clinical characteristics were collected to evaluate the treatment efficacy and drug side effects.Results:There were 107 children in each of the two groups with a median age of 8（5，11）years. The median age of the dexamethasone-treated group was 9（6，12）years and the mean age of the dexamethasone-untreated group was 7（3，10）years. The proportion of male children was 69.60%（149/214）；the onset of illness was mostly concentrated within 72 hours，accounting for 97.20%（208/214）of the cases；83.18%（178/214）of the cases had symptoms of combined upper respiratory tract infection before entering the plateau. The most important clinical symptoms of the children were cough（86.92%，186/214），cyanosis（70.09%，150/214），and shortness of breath（66.36%，142/214）. The proportion of auscultatory rhonchi was 83.18%（178/214），and all cases showed positive findings on chest radiography. After the dexamethasone regimen，the overall cure rate of the children was 94.39%，the average disappearance time of the symptoms and signs was（40.52±7.85）h，and the average hospital stay was（3.60±1.90）d. After treatment with the dexamethasone-free regimen，the overall cure rate was 92.52%，the mean time to disappearance of symptoms and signs was（42.10±7.62）h，and the mean length of stay in the hospital was(3.84±2.08)d. There was no significant difference in the cure rate，the disappearance time of symptoms and signs，and the average hospitalisation days between the two groups（ P>0.05），but a total of 11 children in the dexamethasone-treated group experienced adverse drug reactions，and no children in the dexamethasone-untreated group experienced adverse drug reactions. Conclusion:Han Chinese male children，particularly those with upper respiratory infections，should be closely monitored for HAPE risk within three days of ascending to high altitudes. This study does not recommend the use of dexamethasone for pediatric HAPE due to the lack of therapeutic benefits and potential adverse effects.

Aim To evaluate the effect of hemoperfusion on carotid artery elasticity in patients undergoing hemo-dialysis using shear wave elastography(SWE).Methods Seventy-eight patients with uremia were included,and di-vided into two groups based on dialysis regimen:hemodialysis alone group and hemodialysis combined with hemoperfusion group,while 40 healthy subjects were selected as control group.Then general information,clinical data and biochemical indices were collected.The carotid intima-media thickness(IMT),carotid artery inner diameter at the end of systole(Ds),the carotid artery inner diameter at the end of diastole(Dd)and the peak systolic flow velocity(PSV)were meas-ured by conventional ultrasound.The degree of arterial wall motion(△D)and arterial stiffness coefficient(β)were cal-culated.Elasticity of intima-medial layer in the anterior carotid artery was measured by SWE,including the maximum modulus of elasticity(MEmax),mean modulus of elasticity(M Emean),minimum modulus of elasticity(MEmin).Re-sults There were no statistically significant differences in Ds,Dd,△D and PSV among the three groups(all P＞0.05).Compared with control group,the IMT,β,SWE parameters were significantly increased in the hemodialysis combined with hemoperfusion group and the hemodialysis alone group.Compared with hemodialysis alone group,the SWE parameters were significantly decreased in the hemodialysis combined with hemoperfusion group(P＜0.05),while there were no statis-tically significant differences in IMT and β(both P＞0.05).In the three groups,SWE parameters were positively correla-ted with IMT,β and LDLC(r＞0.37,all P＜0.01)and negatively correlated with HDLC(|r|＞0.24,all P＜0.05).The areas under the ROC curves of the SWE parameters were all higher than those of the conventional ultrasound parameters(all P＜0.05).Conclusion SWE can effectively assess the effect of hemoperfusion on the elasticity of carotid arteries in uremic patients undergoing hemodialysis.

Aim To evaluate the right atrial function by two-dimensional speckle tracking imaging(2D-STI)combined with real-time three-dimensional echocardiography(RT-3DE)in patients with triple vessel coronary artery disease(TVCAD)without myocardial infarction.Methods Fifty-six patients with TVCAD without myocardial infarc-tion were selected and divided into two groups according to the results of coronary angiography:28 cases with a stenosis rate of 50％～75％and 28 cases with a stenosis rate of ≥75％.In addition,30 healthy volunteers were screened as control group.RT-3DE was performed to obtain the parameters of right atrial volume(RAVmax,RAVmin and RAVp)and then calculated right atrial passive ejection fraction(RAPEF)and right atrial active ejection fraction(RAAEF),and the maxi-mum of right atrial volume index(RAVImax).2D-STI was applied to measure right atrium strain rates during systole,ear-ly diastole and late diastole(RASRs,RASRe and RASRa).Correlation between 2D-STI parameters and N-terminal pro-brain natriuretic peptide(NT-proBNP),Gensini scores were analyzed by Pearson analysis.ROC curve analysis was used to evaluate the diagnostic value of 2D-STI,RT-3DE,and their combined use for right atrial function in TVCAD patients without myocardial infarction.Results Compared with control group,RAPEF and RASRe reduced in stenosis rate of 50％～75％group,while RAAEF and RASRa increased(all P＜0.05).Compared with control group and stenosis rate of 50％～75％group,RAPEF,RASRs,RASRe and RASRa decreased,while RAVmax,RAVmin,RAVp,RAVImax and RAAEF increased in stenosis rate of ≥75％group(all P＜0.05).There was a significant correlation between 2D-STI pa-rameters and NT-proBNP and Gensini scores.The area under the curve of right atrial function in TVCAD patients without myocardial infarction was 0.9048,0.8917 and 0.9564 for 2D-STI,RT-3DE and their combined use,respectively.The diagnostic efficacy of the two methods was significantly higher when used in combination than when used alone,and 2D-STI was superior to RT-3DE.Conclusion When evaluating the right atrial function of TVCAD patients without myocardial infarction,the diagnostic efficacy of 2D-STI combined with RT-3DE is higher than that of using it alone,and 2D-STI is su-perior to RT-3DE.

Objective:To analyse the clinical characteristics of 214 cases of paediatric high altitude pulmonary edema（HAPE）and the efficacy of dexamethasone in adjunctive therapy.Methods:This retrospective study analyzed 214 pediatric cases of HAPE admitted to the Department of Paediatrics of the General Hospital of Tibetan Military between June 2015 to June 2017 and June 2019 to June 2021.Patients were divided into dexamethasone-treated group and dexamethasone-untreated group.Baseline data，clinical characteristics were collected to evaluate the treatment efficacy and drug side effects.Results:There were 107 children in each of the two groups with a median age of 8（5，11）years. The median age of the dexamethasone-treated group was 9（6，12）years and the mean age of the dexamethasone-untreated group was 7（3，10）years. The proportion of male children was 69.60%（149/214）；the onset of illness was mostly concentrated within 72 hours，accounting for 97.20%（208/214）of the cases；83.18%（178/214）of the cases had symptoms of combined upper respiratory tract infection before entering the plateau. The most important clinical symptoms of the children were cough（86.92%，186/214），cyanosis（70.09%，150/214），and shortness of breath（66.36%，142/214）. The proportion of auscultatory rhonchi was 83.18%（178/214），and all cases showed positive findings on chest radiography. After the dexamethasone regimen，the overall cure rate of the children was 94.39%，the average disappearance time of the symptoms and signs was（40.52±7.85）h，and the average hospital stay was（3.60±1.90）d. After treatment with the dexamethasone-free regimen，the overall cure rate was 92.52%，the mean time to disappearance of symptoms and signs was（42.10±7.62）h，and the mean length of stay in the hospital was(3.84±2.08)d. There was no significant difference in the cure rate，the disappearance time of symptoms and signs，and the average hospitalisation days between the two groups（ P>0.05），but a total of 11 children in the dexamethasone-treated group experienced adverse drug reactions，and no children in the dexamethasone-untreated group experienced adverse drug reactions. Conclusion:Han Chinese male children，particularly those with upper respiratory infections，should be closely monitored for HAPE risk within three days of ascending to high altitudes. This study does not recommend the use of dexamethasone for pediatric HAPE due to the lack of therapeutic benefits and potential adverse effects.

Objective To establish a nomogram model for efficiently predicting overall survival(OS)and cancer-specific survival(CSS)in patients with CRCHBM.Method 2239 patients from 2010 to 2019 were retrospectively analyzed from the Surveillance,Epidemiology,and End Results Program(SEER)databases and Wuhan Union Hospital Cancer Center.SEER is randomly assigned to the training and internal validation cohorts,and the Wuhan database serves as the external validation.Cox regression analyses were used to determine the independent clinicopathological prognosis factors affecting OS and CSS,and a nomogram was constructed to predict OS and CSS.The clinical utility of columnar plots was assessed using calibration curves,area under the curve(AUC),and decision curve analysis(DCA).Result OS column line graphs were constructed based on nine independent predictors:age,tumor location,degree of differentiation,tumor size,TNM stage,chemotherapy,primary focus surgery,number of lymph nodes sampled,and serum carcinoembryonic antigen(CEA)level.The C-index of the nomogram to predict the 1-,3-,and 5-year OS were 0.764,0.790,and 0.805 in the training group,0.754,0.760,and 0.801 in the internal validation group,and 0.822,0.874,and 0.906 in the external validation group.CSS column line graphs were constructed based on 3 independent predictors of TNM staging,radiotherapy and chemotherapy.The 1-,3-,and 5-year CSS AUROC values of the training group were 0.791,0.757,and 0.782,respectively.0.682,0.709,0.625 in the internal validation group and 0.759,0.702,0.755 in the external validation group,respectively.The results of receiver operating characteristic curve(ROC),ROC and DCA showed that the use of our model was more effective in predicting OS and CSS than other single clinicopathological features.Conclusion In summary,the nomogram based on significant clinicopathological features can be conveniently used to predict OS and CSS individually in patients with CRCHBM.

Objective:To explore the surgical technique and efficacy of pure retroperitoneoscopic extravesical standardized seeable (P.R.E.S.S.) technique for bladder cuff excision (BCE).Methods:Ninety five patients with UTUC from five domestic centers (30 cases from Changzheng Hospital, 21 cases from Peking University First Hospital, 20 cases from Yuhuangding Hospital, 21 cases from Dalian Medical University affiliated No.2 Hospital and 3 cases from General Hospital of Eastern Theater Command)between August 2017 and December 2020 were retrospectively analyzed. There were 57 males and 38 females with a mean age of (67.7±10.0) years and median tumor size of 3.0 cm. All patients underwent pure retroperitoneoscopic radical nephroureterectomy with a single surgical position and four (36 cases) or five (59 cases) trocar layout according to the surgeon’s prefer habit and experience. The demographics of the two groups were the age of [(66.3±11.2)years vs. (68.6±9.1)years], male/female ratio of (25/11 cases vs. 32/27 cases), body mass index of [(25.0± 3.0)kg/m 2 vs. (24.8±3.4)kg/m 2], tumor maximum diameter of [2.8(1.6, 3.5)cm vs. 3.0(2.0, 4.0)cm], left/right side tumor of(19/17 cases vs. 34/25 cases), T 1-2/T 3-4/Tis stage of(25/10/4 cases vs. 49/10/0 cases), and multifocal tumors of(3 cases vs. 2 cases), and the difference was not statistically significant( P>0.05). On the other hand, the differences of hydronephrosis of the operated kidney(13 cases vs. 39 cases, P=0.004), and tumor location (in renal pelvis or calyx or upper/middle/lower ureter being 23/9/4 cases vs. 35/4/20 cases, P=0.005), were statistically significant. The umbilical artery cord was used as anatomical landmark in the process of P. R.E.S.S. bladder cuff excision. The pelvic floor and extraperitoneal space around the ureter were expanded, the bladder wall was opened to form pneumovesicum, and a sufficient bladder cuff resection and exact bladder cuff closure was performed. Perioperative outcomes and follow-up data were analyzed, and the clinical outcomes between the four and five trocars were compared to evaluate the impact of trocar layout on the surgical outcomes. Results:There were 91(95.8%) cases successfully undergoing P. R.E.S.S. BCE technique, with one case converted to open BCE due to bleeding and three cases converted to distal ureter Hem-o-lok clipping because of poor exposure. Median operative time was 180(125, 230)min, and estimated blood loss was 100(50, 100)ml. The overall complication rate was 10.5%(10/95), including 2 cases(2.1%) of intraoperative bleeding, with 1 case treated by transfusion (400 ml), the other case converted to open surgery without transfusion. There were 8 cases of postoperative complications(8.4%), including 7 cases of Clavien-Dindo grade Ⅱ(3 cases of secondary hemorrhage, one case for each of drug allergy, acute renal insufficiency, blood creatinine increased to 490 μmol/L, or lung infection with lymphatic leakage), 1 case of grade Ⅲa(intestinal obstruction treated with insertion of the intestinal obstruction catheter under local anesthesia), and all these patients were discharged smoothly. The difference between the four and five trocars was not statistically significant in the following variables, including the rate of surgical conversion(8.3% vs. 1.7%), estimated intraoperative blood loss(100 ml vs. 60 ml), ratio of intraoperative lymph node dissection (25.0% vs.20.3%), P. R.E.S.S. bladder cuff excision success rate(91.7% vs.98.3%), the incidence of intraoperative and postoperative complications (13.8% vs.8.5%), pT 1-2/pT 3-4/pTis stage(22/11/3 cases vs.37/19/3 cases) and the proportion of recurrence or metastasis(8.3% vs.3.4%)(all P>0.05). However, the differences in the operation time(190 min vs.170 min, P=0.011)and postoperative hospital stay(5 d vs.6 d, P=0.005) were statistically significant. Conclusions:P. R.E.S.S. bladder cuff resection technique is safe and feasible during the procedure of pure retroperitoneoscopic radical nephroureterectomy by a single surgical position and facilitates seeable adequate bladder cuff excision by establishing an enlarged pelvic lateral extraperitoneal space and pneumovesicum. Five-trocar technique is more suitable for patients with lower ureteral tumors but may be associated with a longer postoperative hospital stay compared with the four-trocar technique.

To address the increasing need for detecting and validating protein biomarkers in clinical specimens, mass spectrometry (MS)-based targeted proteomic techniques, including the selected reaction monitoring (SRM), parallel reaction monitoring (PRM), and massively parallel data-independent acquisition (DIA), have been developed. For optimal performance, they require the fragment ion spectra of targeted peptides as prior knowledge. In this report, we describe a MS pipe-line and spectral resource to support targeted proteomics studies for human tissue samples. To build the spectral resource, we integrated common open-source MS computational tools to assemble a freely accessible computational workflow based on Docker. We then applied the workflow to gen-erate DPHL, a comprehensive DIA pan-human library, from 1096 data-dependent acquisition (DDA) MS raw files for 16 types of cancer samples. This extensive spectral resource was then applied to a proteomic study of 17 prostate cancer (PCa) patients. Thereafter, PRM validation was applied to a larger study of 57 PCa patients and the differential expression of three proteins in prostate tumor was validated. As a second application, the DPHL spectral resource was applied to a study consisting of plasma samples from 19 diffuse large B cell lymphoma (DLBCL) patients and 18 healthy control subjects. Differentially expressed proteins between DLBCL patients and healthy control subjects were detected by DIA-MS and confirmed by PRM. These data demonstrate that the DPHL supports DIA and PRM MS pipelines for robust protein biomarker discovery. DPHL is freely accessible at https://www.iprox.org/page/project.html?id=IPX0001400000.