ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

Objective To measure the urethral meatus circumference in middle-aged and elderly males to undergo surgery for benign prostatic hyperplasia (BPH), and to collect data for developing endoscopic equipment suitable for the male urethra in China. Methods Clinical data were collected from patients (aged ≥50 years) who underwent transurethral resection of prostate in the First Affiliated Hospital of Xi'an Jiaotong University during Jan. and Dec. 2024. All patients had the urethral meatus circumference measured with a metal urethral probe before surgery, followed by the use of a F26.5 endoscopic sheath for surgery. The passage of urethral meatus using different types of metal urethral probes were observed. Results For the 183 patients, the types of endoscopic sheath smoothly passing through the urethral meatus were distributed as follows:42 cases (22.95%) with F26 or above, 66 cases (36.07%) with F25-26, 27 cases (14.75%) with F23-24, 26 cases (14.21%) with F21-22, 22 cases (12.02%) with F20 or below, and the smallest was F17 (1 case). Of all patients, 59.02% (108/183) were able to insert the F26.5 endoscopic sheath smoothly into the urethral meatus (≥F25), 28.96% (53/183) required force or urethral dilation before inserting (F21-F24), and 12.02% (22/183) needed to open the urethral meatus before inserting the endoscopic sheath (≤F20). Conclusion When the most common F26.5 endoscopic sheath is used, 40.98% of the patients have the possibility of urethral injury, which is significantly too big for male transurethral surgery. For patients undergoing transurethral BPH surgery, a thinner sheath should be used to reduce the possibility of urethral injury and secondary iatrogenic urethral stricture.

Objective To explore the clinical value of preoperative assessment and intraoperative frozen section pathology in screening patients suitable for testicular preservation surgery, so as to provide reference for reducing unnecessary radical orchiectomy in patients with benign testicular tumors. Methods A retrospective analysis was conducted on 121 patients who underwent surgical treatment for testicular tumors in the First Affiliated Hospital of Xi'an Jiaotong University during Jan. 2021 and Sep. 2025. Data were collected, including demographic information, preoperative imaging, serum tumor markers, surgical procedures, intraoperative frozen section, postoperative pathology, and postoperative testicular volume changes. Results Among the 121 patients, 105 underwent radical orchiectomy, with 91 malignant and 14 benign cases confirmed by postoperative pathology; 16 received testicular tumor enucleation, all confirmed as benign. Benign lesions accounted for 24.79% (30/121) of all cases. In patients undergoing tumor enucleation, intraoperative frozen section results were fully consistent with final pathological findings. Conclusion Preoperative differentiation between benign and malignant testicular tumors is crucial for selecting the appropriate surgical approach. For patients with preoperative findings suggesting benign lesions, testicular tumor enucleation combined with intraoperative frozen section can achieve precise treatment while maximizing testicular preservation.

Diabetic kidney disease(DKD)is a microvascular complication of diabetes mellitus with a complex pathogenesis.Recent studies have revealed that autophagy and ferroptosis,as two forms of programmed cell death,exhibit dynamic interactions in DKD:autophagy maintains homeostasis by eliminating damaged organelles,while ferroptosis is driven by iron-dependent lipid peroxidation.Imbalance between the two exacerbates renal injury.This review systematically summarizes the signaling pathways and key regulatory factors related to autophagy and ferroptosis,as well as their interaction mechanisms[such as nuclear receptor coactivator 4(NCOA4)-mediated ferritinophagy,clock autophagy,and lipid autophagy].It further elaborates the molecular network by which these processes synergistically regulate DKD progression.Additionally,the potential of modern pharmaceuticals and active components of traditional Chinese medicine to improve kidney injury by targeting autophagy and ferroptosis is discussed,proposing that targeting their cross-talk pathways may provide novel therapeutic strategies for DKD,aiming to lay a theoretical foundation for the development of targeted intervention strategies and precision therapeutic regimens.

AIM To investigate the clinical effects of Mahuang Fuzi Xixin Decoction combined with non-immunosuppressive treatment on patients with focal segmental glomerulosclerosis due to Spleen-Kidney Yang Deficiency.METHODS Sixty patients were randomly assigned into control group(30 cases)for 24-week intervention of non-immunosuppressive treatment,and observation group(30 cases)for 24-week intervention of both Mahuang Fuzi Xixin Decoction and non-immunosuppressive treatment.The changes in clinical effects,TCM syndrome effects,TCM syndrome score,24 h UTP,ALB,eGFR,Nephrin,Podocin and safety indices were detected.RESULTS The observation group demonstrated higher total effective rate and TCM syndrome effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased TCM syndrome score,24 h UTP,Nephrin,Podocin(P＜0.05),and increased ALB(P＜0.05),especially for the observation group(P＜0.05).No obvious adverse reactions occured in the two groups.CONCLUSION For the patients with focal segmental glomerulosclerosis due to Spleen-Kidney Yang Deficiency,Mahuang Fuzi Xixin Decoction combined with non-immunosuppressive treatment can improve TCM syndromes,whose action mechanism may be contribute to the alleviation of podocyte injury.

Objective:To explore the feasibility of using low-dose computed tomography(LDCT)with deep learning reconstruction(DLR)on the chest for the screening of lung nodules,and to compare the image quality and detection rate of nodules between LDCT and routine dose CT(RDCT)-DLR.Methods:A total of 104 overweight or obese patients[body mass index(BMI)≥25 kg/m2]who received CT examination on chest due to pulmonary nodule screening from September to December 2023 were included to conduct prospective study.All patients underwent respectively RDCT(120 kV)and LDCT(100 kV)scans,all of the two scans used the modulation of automatic tube current,and adopted deep learning AI algorithm ClearInfinity to conduct reconstruction(RDCT:CI 40%,LDCT:CI 50%).Radiation dose and nodules number of them were recorded.At the T8 vertebral level,CT values(Hounsfield Units,HU)of mediastinal fat and lung parenchyma in the right lower lobe were measured,along with image noise(standard deviation,SD).The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were subsequently calculated.Two radiologists independently performed subjective evaluations of image quality and pulmonary nodules using a Likert 4-point scale.Paired t-tests or Wilcoxon rank-sum test were employed to compare differences in radiation dose,objective image noise,and subjective scores between LDCT and RDCT.Results:A total of 104 patients were enrolled,including 54 males and 50 females,with a mean age of 52±13 years and a BMI of(27.77±2.64)kg/m2.The effective radiation dose of LDCT demonstrated a statistically significant reduction compared to RDCT(Z=-8.853,P<0.001),with a mean effective radiation dose reduction of 77.86%.The differences in lung CT value,lung noise,fat noise,lung parenchyma SNR,fat SNR and CNR of images between two groups were significant(Z=-3.022,-2.327,-4.785,-2.059,-3.765,-4.013,P<0.05),while there were not significant differences in the comparisons for fat CT value and lung parenchyma SNR(P>0.05).The image contrast,image noise,and subjective score for image quality of lung nodule of LDCT were lower than those of RDCT(t=2.877,2.387,5.096,P<0.05),but all subjective scores of that were>3,which can meet the requirements of clinical diagnosis.In terms of nodule detection,RDCT found out about 418 nodules,while LDCT found out about 421,the false positive rate of LDCT only was 0.72%.Conclusion:In overweight or obese patients,LDCT that combined with DLR algorithm on chest is equivalent to RDCT on image quality and the detection rate of lung nodule,and it significantly reduce radiation exposure on patients at the same time.

Objective:To compare the efficacy and safety of Rotarex mechanical thrombectomy (Rotarex) combined with drug-coated balloon (DCB) versus percutaneous transluminal angioplasty (PTA) combined with DCB in the treatment of femoropopliteal artery in-stent restenosis (ISR).Methods:A multicenter, prospective, randomized controlled trial was conducted. 46 patients with femoropopliteal artery ISR admitted to five hospitals (Beijing Friendship Hospital, Capital Medical University; Beijing Chaoyang Hospital, Capital Medical University; Beijing Jishuitan Hospital, Capital Medical University; Xuanwu Hospital, Capital Medical University; Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University) from July 2020 to June 2024 were enrolled. Patients were randomly divided into the Rotarex+ DCB group ( n=24) and the PTA+ DCB group ( n=22) using a random number table. The clinical data of the two groups were collected, including clinical characteristics, Fontaine classification, stent placement location, stent duration, and lesion length. The primary endpoint was the target blood vessel patency rate at 6 and 12 months postoperatively; the secondary endpoints included improvement in clinical symptoms (Fontaine classification), rate of reintervention, and safety indicators. Measurement data were expressed as mean±standard deviation ( ± s), and the t-test was used for comparison between groups; count data were expressed as the number of cases and percentages, and intergroup comparisons were performed using the Chi-test or Fisher exact probability method. Results:At 12 months postoperatively, the target blood vessel patency rate in the Rotarex+ DCB group was significantly higher than that in the PTA+ DCB group (81.8% vs 45.5%, P=0.012), and the proportion of patients in Fontaine classification stage I was also higher (86.4% vs 45.5%, P=0.004). The results at the 6-month follow-up were consistent (target blood vessel patency rate: 87.0% vs 59.1%, P=0.035). In terms of safety, no severe complications such as arterial rupture, amputation, or procedure-related death occurred during the perioperative period in either group. During the postoperative follow-up, no amputation or procedure-related deaths occurred in either group. Conclusion:For the treatment of femoropopliteal artery ISR, Rotarex mechanical thrombectomy combined with DCB is significantly superior to PTA+ DCB in terms of 12-month target blood vessel patency rate and improvement of clinical symptoms, with comparable safety.

OBJECTIVE: To explore the clinical characteristics and genetic etiology of a patient with De-differentiated liposarcoma (DDLPS). METHODS: A 38-year-old female patient with DDLPS who had visited Hunan Provincial People's Hospital in January 2025 was selected as the study subject. A retrospective study method was adopted to collect the patient's clinical data, including current and past medical history, auxiliary examinations, pathological diagnosis, and results of genetic testing. This study was approved by the Ethics Committee of Hunan Provincial People's Hospital (Ethics No.: KY2025-150). RESULTS: The patient had presented with abdominal pain and abdominal mass. Imaging studies revealed ascites and space-occupying abdominal lesions. Postoperative pathological examination showed that the tumor was composed of spindle cells, and its morphology and immunohistochemistry had made it difficult to distinguish between DDLPS and leiomyosarcoma. High-throughput sequencing revealed characteristic molecular alterations of DDLPS, and fluorescence in situ hybridization confirmed MDM2 gene amplification, leading to a diagnosis of DDLPS. CONCLUSION The patient was diagnosed with DDLPS. Her clinical manifestations and pathological features were consistent with the characteristics of DDLPS. Molecular pathological testing played a crucial role in the diagnosis and provided a crucial reference for subsequent treatment.
Humans ; Female ; Adult ; Liposarcoma/diagnosis* ; Phenotype ; Proto-Oncogene Proteins c-mdm2/genetics*

This article introduces the experience of Academician SHI Xuemin in treatment of stroke combined with obstructive sleep apnea hypopnea syndrome. It is believed that this disease is the syndrome of "stroke of lung qi exhaustion". It is rooted at the deficiency of primary qi, and lung qi declining; and characterized by phlegm stagnation, qi reversion and mind blockage. This disease is manifested as somnolence-like symptoms, snoring-like breathing and sawing-like expectorating. The therapeutic regimen focuses on "governing qihai (sea of qi ), regulating the spirit and adjusting the orifice closure". The main acupoints include Neiguan (PC6), Shuigou (GV26) and Sanyinjiao (SP6) to regain the consciousness and open the orifices. Besides, Renying (ST9) is added to regulate the respiration, Baihui (GV20) and Sishencong (EX-HN1) to harmonize the spirit, and Fengchi (GB20), Wangu (GB12) and Yifeng (TE17) to open the orifice for the treatment of symptoms. It provides a new idea for the clinical diagnosis and treatment of stroke with accompanying symptoms.
Humans ; Sleep Apnea, Obstructive/complications* ; Acupuncture Therapy ; Stroke/physiopathology* ; Male ; Acupuncture Points ; Female ; Middle Aged ; Qi ; Aged ; Lung/physiopathology* ; Snoring/physiopathology* ; Adult ; Drugs, Chinese Herbal/administration & dosage*

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.