AIM: To explore the factors affecting the whole-eye astigmatism after pterygium excision combined with autologous limbal stem cell transplantation.METHODS: A retrospective analysis was conducted on the medical records of 42 patients(42 eyes)with primary pterygium admitted in the ophthalmology department of Xijing Hospital from January 2023 to October 2023. They underwent pterygium excision combined with autologous limbal stem cell transplantation. The maximum invasion depth of pterygium into the cornea was measured with anterior segment optical coherence tomography(AS-OCT)before operation, the length of the pterygium invading cornea, the width of the limbus and the area of the invading cornea were measured during the operation, and three-dimensional values of corneal astigmatism of anterior segment, index of surface variance(ISV), index of vertical asymmetry(IVA), best corrected visual acuity(BCVA)and whole-eye astigmatism were collected before and at 1 mo after surgery. Patients with astigmatism ≤0.50 D or >0.50 D of the whole eye at 1 mo after surgery were assigned to group A and B, respectively. The differences of clinical data before and at 1 mo after surgery between the two groups, and the correlation between pre-operative clinical indicators and whole-eye astigmatism were analyzed. The decision tree algorithm was performed to explore the influencing factors of whole-eye astigmatism at 1 mo postoperatively.RESULTS: The maximum invasion depth of pterygium in the group A was significantly less than that in the group B [80.00(40.00, 180.00)μm vs 175.00(123.00, 190.00)μm, P=0.002]. Preoperative BCVA(LogMAR), whole-eye astigmatism, cornea astigmatism, ISV, IVA and maximum invasion depth of pterygium were positively correlated with whole-eye astigmatism at 1 mo after surgery(rs=0.317, P=0.041; rs=0.545, P<0.001; rs=0.448, P=0.003; rs=0.389, P=0.011; rs=0.382, P=0.013; rs=0.391, P=0.010). The decision tree algorithm screened out two influential factors: the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. The risk of whole-eye astigmatism >0.50 D at 1 mo after operation was higher with maximum invasion depth of pterygium into the cornea >95 μm than that with ≤95 μm. Among the patients with whole-eye astigmatism >2.63 D before operation, the probability of residual whole-eye astigmatism >0.50 D was 88.9%, and the predictive model AUC was 0.804.CONCLUSION: The whole-eye astigmatism after pterygium resection is mainly affected by the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. When the maximum invasion depth of pterygium into the corneal is >95 μm and the whole-eye stigmatism is >2.63 D before surgery, the patient should receive surgical treatment as soon as possible in order to obtain good clinical benefits.

BACKGROUND: Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery. METHODS: PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed. RESULTS: PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model. CONCLUSIONS: The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes. TRIAL REGISTRATION ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Algorithms ; Lung Diseases/etiology* ; Machine Learning ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications/diagnosis* ; Risk Factors ; ROC Curve

The monkeypox pandemic has caused two public health emergencies of international concern from 2022 to 2025,causing great impact on the global health system. Early diagnosis and treatment of the monkeypox virus depend on quick, sensitive, and accurate detection methods. The clustered regular interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) system, characterized by its unique target gene sequence recognition, and cis-and trans-cleavage activity, has been regarded as the next-generation nucleic acid detection tool in the field of pathogen diagnosis. CRISPR/Cas has been used for detecting monkeypox virus in combination with different amplification and result readout approaches. Although it still faces many challenges, the CRISPR/Cas system is expected to achieve diversified development and provide strong technical support for rapid, accurate, and affordable detection approaches for infectious diseases.

Objective To investigate the relationship between exposure to foodborne antibiotics and gut microbiota,as well as its impact on irritable bowel syndrome(IBS).Methods A total of 100 IBS patients(IBS group)and 100 healthy controls(control group)were enrolled in this case-control study.Antibiotic ex-posure was assessed by serum detection,and gut microbiota composition was analyzed by 16S rRNA gene se-quencing technology.Binary Logistic regression model and chi-square test were used for statistical analysis to explore the relationship between antibiotic exposure and IBS,and to analyze the differences in gut microbiota.Results The antibiotic exposure rate of IBS group was significantly higher than that of control group(59％vs.36％,P=0.016),and the exposure to β-lactam antibiotics was significantly different between the two groups(P=0.047).In addition,the composition of gut microbiota in the IBS group was significantly different from that in the control group,and the abundance of Firmicutes was increased(P＜0.001),while the abun-dance of Lactobacillus,Bifidobacterium and Faecalibacterium was decreased(P＜0.001).Conclusion Food-borne antibiotic exposure may be one of the risk factors for IBS,and antibiotic exposure may affect the occur-rence and development of IBS by changing the composition of gut microbiota.Foodborne antibiotic exposure may be a risk factor for inducing IBS and could affect the disease process by altering the structure of the gut microbiota.Therefore,enhancing the regulation of foodborne antibiotic use and raising public awareness about the importance of minimizing foodborne antibiotic exposure can effectively prevent and reduce the incidence of IBS.

Objective To investigate serum vitamin D levels of healthy children in Beijing and to analyze the factors affecting vitamin D level.Methods Healthy children aged 1-14 years old who underwent physical examination in department of pediatrica,Civil Aviation General Hospital from September 2016 to September 2020 were randomly selected as research objects.Clinical data of the children were collected and a questionnaires survey was conducted.The level of 25-hydroxy vitamin D[25-(OH)D]was detected by liquid chromatography-tandem mass spectrometry.Serum 25-(OH)D levels were compared between different groups(grouped by age,gender,season,outdoor activity time,and vitamin D supplementation).Results A total of 990 children met the inclusion criteria.There were 500 boys and 490 girls,with a mean age of(6.42±3.50)years old.The mean serum level of 25-(OH)D was(28.23±6.74)ng/ml in all the selected children(range,11.70-51.90 ng/ml),(31.99±6.47)ng/ml in young child group,(27.54±6.49)ng/ml in preschool group,and(25.84±5.93)ng/ml in school-age group.The serum level of 25-(OH)D in the young child group was significantly higher than those in the preschool group and school-age group(P<0.05).There was no significant difference in the serum level of 25-(OH)D between the preschool group and school-age group(P>0.05).There were significant differences in the proportions of children with normal 25-(OH)D,insufficient 25-(OH)D and deficient 25-(OH)D among different age groups(P<0.05).There was no significant difference in the serum level of 25-(OH)D between boys and girls in the same age group(P>0.05).There was significant difference in 25-(OH)D levels among different age groups with a same gender(P<0.05).There was no significant difference in the proportions of children with normal 25-(OH)D,insufficient 25-(OH)D,or deficient 25-(OH)D between boys and girls(P>0.05).The level of serum 25-(OH)D and the proportion of children with normal serum 25-(OH)D reached the highest in summer and the lowest in winter.There were significant differences in the serum 25-(OH)D levels and the proportion of children with normal serum 25-(OH)D among different seasons(P<0.05).The serum 25-(OH)D level in children with outdoor activities≥1 h daily was significantly higher than that in children with outdoor activities<1 h daily(P<0.05).There were significant differences in the proportions of normal 25-(OH)D,insufficient 25-(OH)D and deficient 25-(OH)D between children with outdoor activities≥1 h daily and children with outdoor activities<1 h daily(P<0.05).The serum levels of 25-(OH)D in children of never-supplement group and sometimes-supplement group were lower than that in the daily supplement group(P<0.05),and there were significant differences in the proportions of normal 25-(OH)D,insufficient 25-(OH)D and deficient 25-(OH)D among the three groups(P<0.05).Conclusion Vitamin D nutritional status of healthy children in Beijing is good.Serum 25-(OH)D level decreases with age.No difference is found in the serum 25-(OH)D level between boys and girls in every age group.No abnormal vitamin D level is found in young children.The insufficiency and deficiency of vitamin D exist in preschool and school-age children,which needs to be improved.Vitamin D level in children is related to seasons.Sufficient time of outdoor activities and regular supplementation of vitamin D can help improve vitamin D nutritional status in children.

Objective To investigate the diagnostic value of electromyographic(EMG)tremor indicators for Parkinson's disease(PD)using the Logistic regression model.Methods A total of 65 patients with PD(PD group)and 39 patients with essential tremor(ET)(ET group)were enrolled and underwent EMG tremor analysis.General information,disease-related data,and EMG tremor characteristics were compared between the two groups.Multivariate Logistic regression analysis was performed to screen for independent influencing factors of PD,and receiver operating characteristic(ROC)curves were plotted.The area under the curve(AUC)was used to evaluate the diagnostic value of EMG tremor indicators for PD.Results Compared with the ET group,the PD group had a higher proportion of patients with unilateral onset and those with tremor spectrum frequency≥2 times,and a lower proportion of patients with a family history of tremor(P＜0.05).The tremor peak frequencies in the resting,postural,and weight-bearing(1 000 g)states were lower in the PD group than in the ET group(P＜0.05).There were statistically significant differences in the tremor rhythm patterns between the two groups in the resting and weight-bearing states(P＜0.05),with the PD group dominated by alternating contraction patterns and the ET group by synchronous contraction pat-terns.Multivariate Logistic regression analysis revealed that the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum were independent influencing factors of PD(P＜0.05).The ROC curves showed that the AUCs of the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum for diagnosing PD were 0.886,0.750,and 0.779,respec-tively.The combination of these three indicators yielded the highest AUC(0.936)for diagnosing PD,with a sensitivity of 81.54％and a specificity of 94.87％.Conclusion The tremor peak fre-quency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum provided by EMG tremor analysis can serve as clinical indicators for early diagno-sis of PD,and their combined use offers higher diagnostic value,which can be used to differentiate PD from ET.

Objective To profile ubiquitination in cysteinyl aspartate-specific proteinase-2(CASP2)deficient cells under heat shock and investigate the role of CASP2 in stress response.Methods Ubiquitination levels in subcellular fractions of control and C ASP2 knockout(KO)cells were detected via Western blotting.After 2 hours of heat shock treatment,Soluble Ⅱ and Pellet fractions were collected from both control and CASP2 KO cells for ubiquitinome analysis.Anti-di-glycine remnant(K-ε-GG)antibody-based proteomic analysis was performed to identify differentially ubiquitinated proteins and associated key signaling pathways.Proteins that displayed significantly upregulated ubiquitination in CASP2 KO cells under heat shock were subjected to His-tag pull-down assays to find out whether CASP2 regulated the ubiquitination of these proteins.Results Under heat shock,CASP2 KO cells displayed significantly higher accumulation of overloaded ubiquitinated conjugates in the Pellet fraction compared to controls.Ubiquitinomics analysis revealed substantial alterations in protein ubiquitination patterns following CASP2 KO.One hundred proteins exhibited significantly elevated ubiquitination levels while 36 proteins had their ubiquitination reduced relative to controls.Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis indicated that hyper-ubiquitinated proteins were primarily associated with Huntington disease,Alzheimer disease,bile secretion,carbon metabolism and autophagy.His-tag pull-down assays combined with Western blotting revealed increased ubiquitination of nicotinamide adenine dinucleotide reduced-ubiquinone oxidoreductase 1 beta subcomplex subunit 3(NDUFB3)and autophagy-related protein 9A(ATG9A)in CASP2 KO cells under heat shock.Conclusion Overloaded ubiquitinated conjugates are accumulated due to CASP2 deficiency during heat shock.CASP2 modulates ubiquitination levels through multiple signaling pathways.

Objective To investigate the value of chest contrast-enhanced CT(C-CECT)combined with artificial intelligence iterative reconstruction(AIIR)for bronchial artery(BA)imaging.Methods Seventy patients who underwent C-CECT were prospectively enrolled.The images were reconstructed with AIIR(AIIR group)and hybrid iterative reconstruction(HIR,HIR group),respectively.The overall image quality,the traceability of BA,the sharpness of BA and the diagnostic confidence of abnormalities of BA were subjectively graded using a 5-point scale by two radiologists,respectively.The subjective scores and inter-observer agreement were compared between groups.The noise(SD)in reconstructed images of thoracic aorta,pulmonary trunk,BA and spinal erectors,the contrast-to-noise ratio(CNR)of the above 3 arteries relative to spinal erectors,and the diameters of BA at the origin,bifurcation and pulmonary hilum were compared between groups.Results The scores of the overall image quality,the traceability of BA,the sharpness of BA and the diagnostic confidence of abnormalities of BA were all significantly higher in AIIR group than those in HIR group(all P＜0.001),all with good inter-observer agreement(Kappa=0.46-0.73).SD of the aorta,pulmonary artery trunk,BA and erector spinal muscle in AIIR group were lower than those in HIR group,while CNR of above 3 arteries were higher than those in HIR group(all P＜0.05).No significant difference of the diameter of BA at each position was found between groups(all P＞0.05),while the consistency of measurement of AIIR group was higher than that of HIR group(intra-class correlation coefficient:0.89-0.94 vs.0.63-0.78).Conclusion C-CECT combined with AIIR could significantly improve imaging quality and diagnostic confidence of BA.

Laparoscopic technology has been widely used in the surgical treatment of gastric cancer, but the operating space inside the abdominal cavity is mostly created by CO? artificial pneumoperitoneum. There is a paradoxical result of CO? artificial pneumoperitoneum, which may increase the risk of complications in elderly patients with poor cardiopulmonary function. Therefore, people have been trying non pneumoperitoneum techniques. This article focuses on the establishment of CO? pneumoperitoneum as the core technology of minimally invasive abdominal surgery in laparoscopic minimally invasive techniques both domestically and internationally over the years, as well as the complications caused by CO? artificial pneumoperitoneum. It explores the use of "no pneumoperitoneum" in minimally invasive abdominal surgery and summarizes the exploration of the author's center in this field. The article also looks forward to the prospects of this technology.

Objective To prepare a variety of quality control(QC)materials for SARS-CoV-2 variants as an addition to the conven-tional SARS-CoV-2 nucleic acid QC products for the laboratory detection of mutant strains by optimizing the preparation and purification process of MS2 phage virus-like particle(VLP)technique,and evaluate their performances.Methods The typical mutation sequence fragments or full length S genes were designed and synthesized according to the genomic information of SARS-CoV-2 variants.Then,they were inserted into the downstream of maturase gene,coat protein and the pac-site of MS2 phage to construct a series of recombi-nant expression vectors.After induced by the prokaryotic expression system,the VLP products were purified through the polyethylenei-mine precipitation,ultrafiltration,nuclease digestion,and gel filtration chromatography.The obtained VLP were validated by the nucle-ic acid electrophoresis,protein electrophoresis,protein concentration determination,and fluorescence PCR,and their performances such as nucleic acid residue and stability were also evaluated.Results A total of 10 kinds of VLP containing the targeted sequences of the gene to be tested were prepared.The length of the foreign sequence wrapped in them ranged from 297 bp to 3 822 bp,which could be combined into a variety of QC materials for the mutation detection of different SARS-CoV-2 variants.The prepared VLP QC materials could not be effectively amplified without nucleic acid extraction or reverse transcription steps during the routine nucleic acid detection.The simulated QC samples remained stable after repeated freeze-thaw cycles.They could be stored stably for 2 months at 25 ℃ and 4 weeks at 37 ℃.Conclusion The established preparation and combined purification process of VLP QC materials can encapsulate vari-ous exogenous nucleic acid sequences with different lengths into the viral coat protein to form VLP,with high production efficiency.The VLP QC products prepared by the above process have stable performance and almost no residual exogenous nucleic acid,which can ef-fectively meet clinical requirements and ensure the quality of laboratory testing.