Compared to other refractive surgeries, the implantable collamer lens(ICL)implantation procedure has become one of the most popular surgical options in refractive surgery. ICL surgery offers advantages such as reversibility, high-definition visual outcomes, and preservation of the corneal anatomical structure. The V4c model, which features a central port, is currently the most widely used in clinical practice and eliminates the need for peripheral iridotomy during the perioperative period. Although excellent uncorrected visual acuity can be achieved postoperatively, some patients may experience visual disturbances in the early postoperative period, such as halo and glare, which may affect visual comfort particularly under low-light conditions. This article reviews visual quality metrics after ICL V4c implantation, including higher-order aberrations(HOA), modulation transfer function(MTF), and contrast sensitivity(CS), along with influencing factors, and discusses potential relative deficits in postoperative visual quality and their underlying mechanisms.

Objective:To investigate the safety and efficacy of laparoscopic simultaneous bilateral adrenalectomy in treating ectopic ACTH syndrome (ACTH)caused by medullary thyroid carcinoma(MTC).Methods:A 56-year-old male patient was admitted after MTC surgery and 7 months of general fatigue. The patient had a history of two open thyroid surgeries for medullary thyroid carcinoma, with previous pathological reports indicating lymph node metastasis in the upper mediastinum and mediastinum, accompanied by weak cytoplasmic expression of ACTH and negative CRH staining. After the operation, the patient developed diabetes, hypertension, and hypokalemia. Upon admission, the patient presented with a blood pressure reading of 200/95 mmHg (1 mmHg = 0.133 kPa), a weight of 61.5 kg, a height of 160 cm, a body mass index (BMI)of 24.02 kg/cm 2, and a waist circumference of 83 cm. Laboratory tests revealed the following: blood potassium level of 2.71 mmol/L, blood calcium level of 1.47 mmol/L, parathyroid hormone level of 6.0 pg/ml, fasting blood glucose level of 10.51 mmol/L, glycated hemoglobin level of 8.2%, blood calcitonin level exceeding 2 000 pg/ml, and blood CEA level of 70.8 μg/L. The plasma ACTH levels at 8∶00, 16∶00, and 24∶00 were 189.0, 125.0, and 65.0 pg/ml, respectively. Serum cortisol levels at 08∶00, 16∶00, and 24∶00 were 429.30, 408.14, and 446.61 μg/L, respectively. The 24-hour urine free cortisol measurement was 1 200 μg, and after the midnight 1mg dexamethasone suppression test at 8∶00, the plasma ACTH level was 183.0 pg/ml, and the serum cortisol level was 538.27 μg/L. The aldosterone level in standing position after 2 hours was 8.2 pg/ml. There were no significant abnormality in catecholamine hormone detection or thyroid function in blood and urine samples. An 18F-FDG-PET/CT examination showed multiple lymph node metastases in the neck, while an abdominal CT scan revealed bilateral adrenal hyperplasia. Enhanced MRI revealed pituitary gland thinning, and lung CT and sputum culture examinations showed scattered multiple lung infections. After a multidisciplinary discussion, the patient was diagnosed with EAS, postoperative MTC metastasis, diabetes, hypertension, hypokalemia, pulmonary infection, mild anemia, liver dysfunction, hypoparathyroidism, and hypocalcemia. The patient were accepted laparoscopic bilateral adrenalectomy via an abdominal approach under general anesthesia. The left adrenal gland was removed first, followed by the right adrenal gland after repositioning. Results:The surgery was successful with a surgical duration of approximately 60 minutes and an intraoperative bleeding volume of about 20 ml. No surgical complications occurred during the perioperative period. Pathological examination confirmed nodular hyperplasia of the adrenal cortex and bilateral adrenal medullary hyperplasia with negative ACTH staining. After a 3-month postoperative follow-up, blood calcitonin levels remained above 2000 pg/ml. The blood ACTH levels at 1 week, 1 month, and 3 months after surgery were 183.0, 220.0, and 731.0 pg/ml, respectively. However, hypertension, diabetes, and hypokalemia rapidly improved. One month after surgery, blood pressure was 100/80 mmHg, fasting blood glucose was 4.4 mmol/L, and blood potassium was 3.87 mmol/L. Pulmonary infection showed improvement, and no adrenal crisis occurred. Glucocorticoid replacement therapy consisted of 20 mg of hydrocortisone tablets in the morning and 10 mg in the afternoon, and thyroid hormone replacement therapy involved daily administration of 100 μg of levothyroxine. Genetic testing revealed heterozygous mutations in the Ret gene. The patient is currently undergoing clinical trial treatment with Ret inhibitors.Conclusions:Based on the data from this case and existing literature reports, laparoscopic simultaneous bilateral adrenalectomy might be safe and effective treatment option for EAS caused by unresectable MTC metastasis. It can correct hypertension, diabetes, and hypokalemia and increase the opportunity for MTC treatment.

Metformin has been used for the treatment of type II diabetes mellitus for decades due to its safety, low cost, and outstanding hypoglycemic effect clinically. The mechanisms underlying these benefits are complex and still not fully understood. Inhibition of mitochondrial respiratory-chain complex I is the most described downstream mechanism of metformin, leading to reduced ATP production and activation of AMP-activated protein kinase (AMPK). Meanwhile, many novel targets of metformin have been gradually discovered. In recent years, multiple pre-clinical and clinical studies are committed to extend the indications of metformin in addition to diabetes. Herein, we summarized the benefits of metformin in four types of diseases, including metabolic associated diseases, cancer, aging and age-related diseases, neurological disorders. We comprehensively discussed the pharmacokinetic properties and the mechanisms of action, treatment strategies, the clinical application, the potential risk of metformin in various diseases. This review provides a brief summary of the benefits and concerns of metformin, aiming to interest scientists to consider and explore the common and specific mechanisms and guiding for the further research. Although there have been countless studies of metformin, longitudinal research in each field is still much warranted.
Humans ; Metformin/pharmacokinetics* ; Diabetes Mellitus, Type 2/metabolism* ; Hypoglycemic Agents/pharmacology* ; AMP-Activated Protein Kinases/metabolism* ; Aging

Objective:To explore the safety and efficacy of renal arterial hypothermia perfusion in robot-assisted laparoscopic partial nephrectomy.Methods:The data of 11 patients with complex renal tumors admitted to our hospital from March 2020 to December 2021 were retrospectively analyzed. There were 7 males and 4 females. The patients’age was (64.64±13.56) years old.The median R. E.N.A.L. score was 8 (7, 9) points. Preoperative glomerular filtration rate (GFR) was (64.40±25.52) ml/min. All patients had a renal artery cold solution perfusion robot-assisted laparoscopic partial nephrectomy. 4℃ sodium lactate Ringer's solution was injected into the affected kidney by the catheter, which could provide the kidney a hypothermic state during the operation and protected the renal function during the long period of warm ischemia. The intraoperative data and postoperative complications were recorded. The data of postoperative renal function, routine urine test, urinary CT, preoperative and postoperative glomerular filtration rate (GFR) were analyzed.Results:The renal artery blocking time was (34.09±2.84) min during the surgery. The patients’ body temperature was (36.10±0.44) ℃. The surgical duration was (126.73±47.08) min. The intraoperative bleeding was (81.82±53.07) ml. There were no complications, such as urinary leakage, low body temperature, fever, etc. There was no significant difference between the 3-months postoperative GFR (59.06±25.67) ml/min and preoperative GFR ( P=0.636). Conclusions:For patients with complex renal tumors, renal arterial cold solution perfusion in robot-assisted laparoscopic partial nephrectomy can help obtain longer operative duration during hot ischemia, preserve renal function, and it provide a safe and feasible surgical method for patients.

INTRODUCTION: To improve the nutritional care and resource allocation of critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), we described their characteristics, treatment modalities and clinical outcomes, and compared their nutrition interventions against the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations. METHODS: This was a retrospective observational study conducted in 5 tertiary hospitals in Singapore. Characteristics, treatment modalities, clinical outcomes and nutrition interventions of critically ill patients with SARS-CoV-2 who received enteral and parenteral nutrition were collected between January and May 2020. RESULTS: Among the 83 critically ill patients with SARS-CoV-2, 22 (28%) were obese, 45 (54%) had hypertension, and 21 (25%) had diabetes. Neuromuscular blockade, prone therapy and dialysis were applied in 70% (58), 47% (39) and 35% (29) of the patients, respectively. Refeeding hypophosphataemia and hospital mortality occurred respectively in 6% (5) and 18% (15) of the critically ill patients with SARS-CoV-2. Late enteral nutrition and cardiovascular comorbidities were associated with higher hospital mortality (adjusted relative risk 9.00, 95% confidence interval [CI] 2.25-35.99; 6.30, 95% CI 1.15-34.40, respectively). Prone therapy was not associated with a higher incidence of high gastric residual volume (≥250mL). The minimum caloric (15kcal/kg) and protein (1.2g/kg) recommendations of ASPEN were achieved in 54% (39) and 0% of the patients, respectively. CONCLUSION The high obesity prevalence and frequent usage of neuromuscular blockade, prone therapy, and dialysis had considerable implications for the nutritional care of critically ill patients with SARS-CoV-2. They also did not receive adequate calories and protein. More audits should be conducted to refine nutritional interventions and guidelines for this ever-evolving disease.
COVID-19/therapy* ; Critical Illness/therapy* ; Humans ; Nutritional Support ; SARS-CoV-2 ; Singapore/epidemiology* ; United States

Objective:To evaluate the safety of two inactivated COVID-19 vaccines in a large-scale emergency use.Methods:Based on the "Vaccination Information Collection System", the incidence data of adverse reactions in the population vaccinated with the inactivated COVID-19 vaccines developed by Beijing Institute of Biological Products Co., Ltd and Wuhan Institute of Biological Products Co., Ltd, respectively, in emergency use were collected, and the relevant information were analyzed with descriptive epidemiological and statistical methods.Results:By December 1, 2020, the vaccination information of 519 543 individuals had been collected. The overall incidence rate of adverse reactions was 1.06%, the incidence rate of systemic adverse reactions was 0.69% and the incidence rate of local adverse reactions was 0.37%. The main systemic adverse reactions included fatigue, headache, fever, cough and loss of appetite with the incidence rates of 0.21%, 0.14%, 0.06%, 0.05% and 0.05%, respectively; the main local adverse reactions were injection site pain and injection site swelling with the incidence rates of 0.24% and 0.05%, respectively.Conclusion:The two inactivated COVID-19 vaccines by Beijing Institute of Biological Products Co., Ltd and Wuhan Institute of Biological Products Co., Ltd showed that in the large-scale emergency use, the incidence rate of general reactions was low and no serious adverse reactions were observed after the vaccinations, demonstrating that the vaccines have good safety.

Objective To retrospectively evaluate the influence of prostate volume on prostate cancer detection using elastography targeted transperineal biopsy. Methods A total of 573 consecutive patients suspicious for prostate cancer were enrolled in this study. Patients underwent combined elastography-targeted biopsy and 10 core-systematic transperineal biopsy.In correlation with prostate biopsy pathology, the sensitivity of elastography-targeted biopsy and systematic biopsy were compared among four subgroups with different prostate volume.Results The overall prostate cancer detection rate was 42.9% (246/573). The increase in cancer detection rate by elastography-targeted biopsies was 9.1% (52/573).In patients with prostate volume of ≤30 ml,30-50 ml,50 -80 ml and >80 ml,the sensitivity of elastography targeted biopsy were 91.1% (72/79),81.3% (87/107),70.5% (31/44) and 50.0% (8/16),respectively ( P =0.000).The sensitivity of systematic biopsy were 77.2% (61/79),77.6% (83/107),86.4% (38/44) and 75.0% (12/16),respectively,in comparison among these four groups ( P = 0.601). For patients with prostate volume ≤30 ml,the sensitivity of elastography targeted biopsy was significantly higher than that of systematic biopsy (P= 0.028). Conclusions Prostate cancer detection rate can be improved by elastography targeted biopsy. Prostate volume is correlated with the accuracy of elastography. The sensitivity of elastography targeted biopsy is higher in patients with a smaller prostate gland.

Objective To evaluate the value of preoperative ultrasonographic parameters in predicting the outcome of TURP.Methods A total of 202 patients with symptomatic benign prostatic hyperplasia (sBPH) entering our department for surgical therapy were prospectively recruited,with mean age of (65.5 ± 8.1) years,international prostate symptom score (IPSS) of 16.6 ± 8.1 and quality of life (QOL) score of 5 (3,6).Preoperative combined test of ultrasonography and urodynamics has found total prostate volume (TPV),transitional zone volume (TZV),transitional zone index (TZI),intravesical prostatic protrusion (IPP),resistive index (RI),postvoiding residue (PVR),detrusor wall index (DWT),ultrasonic estimation of bladder weight (UEBW) and maximum flow rate (Qmax) to be (75.0 ±38.5) ml,(49.9 ± 32.4) ml,0.59 ±0.14,(17.2 ±5.0) mm,0.63 ±0.12,(132.7 ±97.8)ml,(16.3 ±7.9)mm,(44.8 ± 7.1)g and (6.1 ± 6.0)ml/s respectively.A 6-monthsfollow-up after standard TURP were applied including re-measurement of IPSS,QOL score and Qmax.The patients were classified into 2 groups of effective and ineffective after the recovery being stratified into 4 levels of none,fair,good and excellent.The influence of preoperative ultrasonographic parameters on surgical outcome was analyzed by logistic regression and receiver operating characteristic (ROC) curve.Results The group of effective has 149 patients,with the preoperative TZI,IPP,RI,DWT and UEBW of 0.65 ± 0.27,(18.3 ± 3.1) mm,0.77 ± 0.18,(19.0 ± 5.0) mm and (46.6 ± 7.1) g,which were significantly higher than that of the group of ineffective (P ＜ 0.05) Lower RI,DWT and UEBW were found to be risk factors of unfavorable surgical efficacy (P ＜ 0.05) from multivariable analysis.The area under curve (AUC) of RI,DWT and UEBW in outcome prediction was 0.816,0.732 and 0.723 respectively from ROC curve,indicating the good predictive value of the 3 parameters with combined positive predictive value (PPV) of 96.3％.Conclusion RI,DWT and UEBW have favorable value in predicting TURP outcome.Measuring these parameters by preoperative ultrasonography might aid in determining the need for surgical intervention in sBPH patients.

Objective To assess transrectal contrast enhanced ultrasound (CEUS ) targeted biopsy (TB) for detection prostate cancer (PCa) by comparing with systematic biopsy (SB) .Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68 8.± 8 0. (47-86) and prostate specific antigen (11 5.± 6 9.)μg/L (0 3.-39 8.μg/L) .CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EV8C4 endfire probe .Hypoperfusion lesions ,hyperperfusion lesions and lesions with rapid wash‐in or wash‐out were suspicious for malignant ,and these lesions were sampled with 2-4 cores in addition with 10‐core SB .Results The overall PCa detection rate was 40 4.% (61/151) .Of 61 PCa patients , 11 (18 0.% ) had positive cores in TB ,18 (23 0.% ) had positive cores in SB and 36 (59 0.% ) had positive cores in both biopsy protocols .The PCa detection rate of TB and SB was 33 1.% and 31 1.% respectively (P=0 7.12) .A total of 1 755 cores were sampled including 1 510 SB cores and 245 TB cores .The positive rate for TB was significantly higher than SB (52 2.% vs 11 5.% ,P =0.000) .Of 61 PCa patients ,18 had low‐grade cancer (Gleason score<7) and 43 had high‐grade cancer (Gleason score≥7) .The sensitivity for high‐grade PCa was 86 0.% with TB ,which was significantly higher than low‐grade cancer (55 6.% ,P =0.018) . Conclusions The PCa detection rate of CEUS‐TB was equal with SB ,whereas the positive rate by core of CEUS‐TB was significant higher than SB .Furthermore ,CEUS‐TB was more sensitive in detection of high grade prostate cancer .

Objective To determine the utility of elastography guided biopsies in men undergoing transrectal ultrasound-guided transperineal prostate biopsies.Methods A total of 108 consecutive patients suspicious for prostate cancer due to elevated serum prostate specific antigen level or abnormal digital rectal examination were enrolled in this prospective study.All patients underwent combined elastography-targeted and 10 core-systematic transperineal biopsy.The impact of elastography-targeted biopsies on the prostate cancer detection rate was analyzed in comparison with prostate biopsy pathology.Results The overall prostate cancer detection rate was 49.1％ (53/108).The prostate cancer detection rate of systematic biopsy was 35.2％(38/108).The increase in cancer detection rate by elastography-targeted biopsies was 13.9％(15/108,P =0.039).A total of 1296 cores were sampled among 108 patients,including 1080 systematic biopsy cores and 216 targeted biopsy cores.The positive rate of targeted biopsy was significantly higher than systematic biopsy (50.9％ vs 14.1％,P ＜0.0001).Conclusions Prostate cancer detection rate could be significantly improved by elastography targeted transperineal biopsy.