Objective To assess the efficacy of endoscopic transethmoidal orbital wall decompression(ETMOWD)in conjunction with fat removal orbital decompression(FROD)on restrictive strabismus in patients with thyroid-associated ophthalmopathy(TAO).Methods A retrospective case series study was conducted involving patients diagnosed with TAO at our hospital from December 2021 to August 2024.Patients were divided into two groups:the orbital decompression group(OD group)and the non-orbital decompression group(NOD group),based on whether they underwent orbital decompression surgery.The study compared perioperative data,types of strabis-mus,degree of ocular motility limitation,extent of posterior migration of ocular muscles,and postoperative outcomes between the two groups.Additionally,the effects of ETMOWD combined with FROD on strabismus were evaluated by analyzing changes in relevant indices before and after surgery in the OD group.Results A total of 65 participants were included in the analysis,with 40 in the OD group group and 25 in the NOD group.There was no statistically significant difference in baseline characteristics between the two groups.Preoperative strabismus types,including horizontal and vertical strabismus,did not differ significantly between the OD and NOD groups(P>0.05).However,the mean preoperative restriction grade of eye movement was significantly higher in the OD group compared to the NOD group.Additionally,the number of surgeries,mean total operated muscles,and number of horizontal muscles were all significantly higher in the OD group than in the NOD group(all P<0.05),with a notably different effect on horizontal muscle migration between the two groups.The degree of restriction of eye movement and diplopia improved significantly in all patients,with cure rates of 70%in the OD group and 72%in the NOD group.Furthermore,the OD group underwent ETMOWD combined with FROD orbital decompression surgery,which resulted in a decrease in intraocular pressure(IOP)from(19.43±3.9)mmHg preoperatively to(15.05±2.2 mmHg postoperatively(P<0.001).Both horizontal and vertical strabismus increased after surgery.Conclusions Our results demonstrated that,compared with the NOD group,the OD group exhibited increased complexity in strabismus surgery,as evidenced by a higher number of operations,total muscle strips,horizontal muscle strips,and greater migratory effect size of the horizontal muscles.The combination of ETMOWD and FROD effectively reduced exophthalmos,with a more pronounced effect on the medial rectus muscle compared to the vertical muscles.However,the long-term outcomes between the two groups were similar.

Cardiac surgery patients often present with multiple comorbidities,the risk of periop-erative complications and the complexity of postoperative rehabilitation have significantly increased,posing higher demands on comprehensive perioperative management.Preoperative exercise pre-reha-bilitation,as a multidisciplinary collaborative intervention strategy,has been demonstrated to signifi-cantly improve the clinical prognosis of patients undergoing elective cardiac surgery by enhancing their cardiopulmonary function,muscle strength,and overall physiological functional reserve,thereby in-creasing the body's tolerance to surgical stress.Although phase-specific research achievements have been made domestically and internationally in the field of exercise pre-rehabilitation,its standardized implementation and clinical translation on a global scale still face numerous obstacles,necessitating systematic review and in-depth exploration.Therefore,this study aimed to conduct a systematic re-view of the intervention protocols,clinical efficacy,safety,and feasibility of preoperative exercise pre-rehabilitation in patients undergoing elective cardiac surgery,with the goal of providing theoretical evidence and practical references for optimizing perioperative management pathways and promoting the implementation of enhanced recovery after surgery concepts.

Objective To explore the predictive value of CT-based fat quantification parameters for early recurrence and recur-rence-free survival(RFS)in pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was conducted on the data of 192 patients with pathologically confirmed PDAC,with 12 months as the threshold for early recurrence.The volume,area,density,index and visceral to subcutaneous fat ratio(VSR)of subcutaneous and visceral fat were calculated in CT portal phase images.Univariate and multivariate Cox regression analyses were performed to identify the independent predictors of early recurrence and RFS by combining clinical characteristics.The association between fat-related parameters and recurrence patterns was evaluated.Results Compared to the non-early recurrence patients,the early recurrence patients exhibited significantly higher body mass index(BMI),visceral fat vol-ume(VFV),visceral fat area(VFA),visceral fat index(VFI),and VSR,as well as significantly lower visceral fat density(VFD)(P＜0.05).Multivariate Cox regression analysis results revealed that VSR,tumor size,alanine aminotransferase(ALT)and carbohydrate antigen 19-9(CA19-9)were independent predictors of early recurrence in PDAC(P＜0.05),while VSR,tumor size,CA19-9 and gender were independent predictors of RFS in PDAC patients(P＜0.05).There were statistically significant differences in BMI,VFA,VFI,VSR,and subcutaneous fat index(SFI)among different recurrence pat-terns(P＜0.05).Conclusion VSR is an independent predictor of early recurrence and RFS in PDAC patients.Fat quantification parameters show significant differences among various recur-rence patterns.

Objective To construct and evaluate an evaluation index system for the training effect of cardiac surgery specialist nurses and provide a reference for the quality evaluation of cardiac surgery specialist nurse training.Methods Based on the Kirkpatrick Model,the preliminary draft of the evaluation index system for the training effect of cardiac surgery specialist nurses was formed through literature review and semi-structured interviews.The Delphi method was used to conduct the expert consultation with 24 experts nationwide in September 2024,and the weight of each index was determined by the analytic hierarchy process.In February 2025,60 cardiac surgery nurses from 3 tertiary A hospitals in Nanjing were selected as the survey subjects,and a satisfaction questionnaire on the evaluation index system for the training effect of cardiac surgery nurses was used for the survey.Results The effective recovery rates of the 2 rounds of expert questionnaires were 96％and 100％,respectively.The expert authority coefficient was 0.913,and the Kendall harmony coefficient was 0.127-0.212 and 0.152-0.176,respectively(both P＜0.05).The final evaluation index system for the training effect of cardiac surgery specialist nurses included 4 primary indexes,14 secondary indexes and 59 tertiary indicators.The satisfaction questionnaire score of the evaluation index system for the training effect of cardiac surgery nurses was(18.75±2.21).Conclusion The evaluation index system for the training effect of cardiac surgery specialist nurses was scientific and reliable,and can guide significance for the subsequent training,assessment and evaluation of cardiac surgery specialist nurses.

Objective To explore the predictive value of CT-based fat quantification parameters for early recurrence and recur-rence-free survival(RFS)in pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was conducted on the data of 192 patients with pathologically confirmed PDAC,with 12 months as the threshold for early recurrence.The volume,area,density,index and visceral to subcutaneous fat ratio(VSR)of subcutaneous and visceral fat were calculated in CT portal phase images.Univariate and multivariate Cox regression analyses were performed to identify the independent predictors of early recurrence and RFS by combining clinical characteristics.The association between fat-related parameters and recurrence patterns was evaluated.Results Compared to the non-early recurrence patients,the early recurrence patients exhibited significantly higher body mass index(BMI),visceral fat vol-ume(VFV),visceral fat area(VFA),visceral fat index(VFI),and VSR,as well as significantly lower visceral fat density(VFD)(P＜0.05).Multivariate Cox regression analysis results revealed that VSR,tumor size,alanine aminotransferase(ALT)and carbohydrate antigen 19-9(CA19-9)were independent predictors of early recurrence in PDAC(P＜0.05),while VSR,tumor size,CA19-9 and gender were independent predictors of RFS in PDAC patients(P＜0.05).There were statistically significant differences in BMI,VFA,VFI,VSR,and subcutaneous fat index(SFI)among different recurrence pat-terns(P＜0.05).Conclusion VSR is an independent predictor of early recurrence and RFS in PDAC patients.Fat quantification parameters show significant differences among various recur-rence patterns.

Objective To construct and evaluate an evaluation index system for the training effect of cardiac surgery specialist nurses and provide a reference for the quality evaluation of cardiac surgery specialist nurse training.Methods Based on the Kirkpatrick Model,the preliminary draft of the evaluation index system for the training effect of cardiac surgery specialist nurses was formed through literature review and semi-structured interviews.The Delphi method was used to conduct the expert consultation with 24 experts nationwide in September 2024,and the weight of each index was determined by the analytic hierarchy process.In February 2025,60 cardiac surgery nurses from 3 tertiary A hospitals in Nanjing were selected as the survey subjects,and a satisfaction questionnaire on the evaluation index system for the training effect of cardiac surgery nurses was used for the survey.Results The effective recovery rates of the 2 rounds of expert questionnaires were 96％and 100％,respectively.The expert authority coefficient was 0.913,and the Kendall harmony coefficient was 0.127-0.212 and 0.152-0.176,respectively(both P＜0.05).The final evaluation index system for the training effect of cardiac surgery specialist nurses included 4 primary indexes,14 secondary indexes and 59 tertiary indicators.The satisfaction questionnaire score of the evaluation index system for the training effect of cardiac surgery nurses was(18.75±2.21).Conclusion The evaluation index system for the training effect of cardiac surgery specialist nurses was scientific and reliable,and can guide significance for the subsequent training,assessment and evaluation of cardiac surgery specialist nurses.

Objective To assess the efficacy of endoscopic transethmoidal orbital wall decompression(ETMOWD)in conjunction with fat removal orbital decompression(FROD)on restrictive strabismus in patients with thyroid-associated ophthalmopathy(TAO).Methods A retrospective case series study was conducted involving patients diagnosed with TAO at our hospital from December 2021 to August 2024.Patients were divided into two groups:the orbital decompression group(OD group)and the non-orbital decompression group(NOD group),based on whether they underwent orbital decompression surgery.The study compared perioperative data,types of strabis-mus,degree of ocular motility limitation,extent of posterior migration of ocular muscles,and postoperative outcomes between the two groups.Additionally,the effects of ETMOWD combined with FROD on strabismus were evaluated by analyzing changes in relevant indices before and after surgery in the OD group.Results A total of 65 participants were included in the analysis,with 40 in the OD group group and 25 in the NOD group.There was no statistically significant difference in baseline characteristics between the two groups.Preoperative strabismus types,including horizontal and vertical strabismus,did not differ significantly between the OD and NOD groups(P>0.05).However,the mean preoperative restriction grade of eye movement was significantly higher in the OD group compared to the NOD group.Additionally,the number of surgeries,mean total operated muscles,and number of horizontal muscles were all significantly higher in the OD group than in the NOD group(all P<0.05),with a notably different effect on horizontal muscle migration between the two groups.The degree of restriction of eye movement and diplopia improved significantly in all patients,with cure rates of 70%in the OD group and 72%in the NOD group.Furthermore,the OD group underwent ETMOWD combined with FROD orbital decompression surgery,which resulted in a decrease in intraocular pressure(IOP)from(19.43±3.9)mmHg preoperatively to(15.05±2.2 mmHg postoperatively(P<0.001).Both horizontal and vertical strabismus increased after surgery.Conclusions Our results demonstrated that,compared with the NOD group,the OD group exhibited increased complexity in strabismus surgery,as evidenced by a higher number of operations,total muscle strips,horizontal muscle strips,and greater migratory effect size of the horizontal muscles.The combination of ETMOWD and FROD effectively reduced exophthalmos,with a more pronounced effect on the medial rectus muscle compared to the vertical muscles.However,the long-term outcomes between the two groups were similar.

Objective:To analyze the clinical characteristics and prognosis of patients with primary aldosteronism (PA) associated with subclinical Cushing syndrome (SCS).Methods:This retrospective cohort study was conducted at the First Affiliated Hospital of Chongqing Medical University in China. Patients with PA were included between January 2014 and December 2022. According to the results of 1-mg overnight dexamethasone suppression test, the patients were divided into the PA group and PA associated with SCS (PA/SCS) group. The demographic information, hormone levels, and follow-up results were analyzed. Independent sample t-test, chi-square test and Mann-Whitney U test were used for data comparison. Results:A total of 489 PA patients were enrolled in this study, of which 109 had PA/SCS (22.3%). Patients with SCS were on average older (54.4±10.7 vs . 47.4±11.0, P<0.001); had a larger proportion of women (69.7%, 76/109 vs . 57.4%, 218/380; P=0.020); and a longer duration of hypertension [96 (36, 180) vs . 60 (12, 120) months, P=0.001] than patients without SCS. There were 215 and 51 patients in the PA group and PA/SCS group, who completed adrenalectomy and follow-up, respectively. The remission rate of autonomous cortisol secretion in the PA/SCS group was 85.3% (29/34). There was no significant difference in the remission rate of autonomous aldosterone secretion among patients between the PA/SCS and PA group (94.1%, 48/51 vs. 94.4%, 203/215; P=1.000), while the clinical remission rate in the PA/SCS group was lower than that in the PA group (39.2%, 20/51 vs. 61.9%, 133/215; P=0.003). Conclusions:SCS is common in PA patients (22.3%), and the clinical remission rate is low. Screening using the 1-mg overnight dexamethasone suppression test is recommended for all patients with PA.

OBJECTIVE To prepare a new antibacterial agent triggered by near infrared light to combat bacterial infection and promote wound healing. METHODS The synthesis of antibacterial agengt was supported by the results from transmission electron microscopy, Ultraviolet-visible absorption spectroscopy and Fourier-transform infrared spectroscopy. The antibacterial agent was irradiated under near infrared(NIR) laser with different concentrations to study the photothermal properties. Release of ciprofloxacin from the antibacterial agent was determined under different conditions. Observed antibacterial activity of the agent by spread plate method and bacterial growth curve. The infected wound was made on the back skin of mice, and the mice were treated with different methods to observe the healing process of the wound and study its influence on the wound healing. RESULTS The synthesized antimicrobial agent could be heated repeatedly without attenuation under near-infrared light, and could still reach a high temperature of 45 ℃ at a low concentration of 125 µg·mL-1. At the same time, it could promote the release of loaded antibiotics, and the release rate reached 86%. Compared with 200 µg·mL-1 solution obtained by physical mixing of polydopamine and ciprofloxacin, the synthesized antimicrobial agent combined with near-infrared light showed more excellent antibacterial ability, and the bacteriostatic rate against Escherichia coli and Staphylococcus aureus was 99.9%. Antimicrobial agents with concentrations of only 0.312 5 µg·mL-1 and 1.25 µg·mL-1 combined with near infrared light significantly inhibited the growth of Escherichia coli and Staphylococcus aureus. Through the mouse skin defect model infected by Staphylococcus aureus, it was proved that the synthetic antibacterial agent still had excellent antibacterial effect in practical application, and could accelerate the healing of infected wound. CONCLUSION The synthesized antimicrobial agents have excellent antibacterial effect in vitro, and still have good antibacterial effect and promote wound healing under the conservative power irradiation without causing skin damage in vivo.

Objective To observe the changes of blood flow density in the macular area of normal eyes,and to analyze its correlation with age.Methods A cross-sectional study.Two hundred and fifty normal healthy subjects (125 males and 125 females,aged 44.76± 14.77) in routine ophthalmologic examination at the Department of Ophtalmology of Guangdong Provincial People's Hospital during June 2017 to June 2018 were enrolled.Among them,20 to 29,30 to 39,40 to 49,50 to 59,and ≥ 60 years old were 50 subjects (50 eyes) in each.BCVA,slit lamp microscope,indirect ophthalmoscope,OCT angiography (OCTA) examinations were conducted for all eyes.The subjects were examined by both eyes,and the data of 1 eye was selected by EXCEL to generate random numbers,including 126 right eyes and 124 left eyes.The range of 6 mm × 6 mm in the macular area was scanned using a frequency domain OCTA instrument.The software automatically divides it into three concentric circles centered on the macular fovea,which were foveal area with a diameter of 1 mm,parafoveal area of 1 to 3 mm,and foveal peripheral area of 3 to 6 mm.The blood flow density of superficial capillary vessel,deep capillary vessel and foveal avascular area (FAZ) within a 300 μm width (FD-300),FAZ area,perimeter (PERIM),non-circularity index,center retinal thickness (CRT) were measured.The relationship between the blood flow density in macula,CRT,FAZ and age was analyzed by Pearson correlation analysis.Results The mean blood flow density of superficial capillary vessel and deep capillary vessel were (51.61 ± 2.54)％ and (54.04± 5.46)％,respectively.The average FD-300,CRT,PERIM and non-circularity index were (285.55 ± 12.13) μm,(2.150 ± 0.367) mm,1.10 ± 0.04,respectively.The relevance of the results showed that the age was negatively correlated with the blood flow density of whole area (r=-0.335,-0.279;P＜0.01),parafoveal area (r=-0.255,-0.368;P＜0.01),foveal peripheral area (r=-0.330,-0.269;P＜0.01) in superficial capillary vessel and deep capillary vessel as well as FD-300 (r=-0.311,P＜0.01),but not correlated with the blood flow density of foveal area (r=-0.071,-0.118;P=0.264,0.064).There was no relationship between the age and the FAZ area,PERIM,non-circularity index (r=-0.070,-0.055,0.074;P=-0.267,0.385,0.142).The age was negatively correlated with the average CRT (r=-0.217,P＜0.01),but not correlated with the CRT in foveal area (r=0.115,P=0.068).The CRT was positively correlated with the blood flow density of superficial capillary vessel and deep capillary vessel in foveal area (r=0.715,0.653;P＜0.01),but negatively correlated with the FAZ area (r=-0.669,P＜0.01).Conclusion The capillary blood flow density ofmacular area in the normal eyes decreases with age.