AIM:To investigate the application of virtual reality(VR)technology in ocular trauma teaching for medical students.METHODS: A total of 90 medical students who participated in the Ophthalmology teaching program between November 2022 and April 2024 were recruited as subjects. Using a case-control method, 45 students in the case group attended traditional ocular trauma teaching program combined with VR virtual simulation experiments, and 45 students in the control group solely attended traditional ocular trauma teaching program. After the teaching practice, the two groups were compared in terms of their examination performance of theoretical knowledge and case analysis, learning ability(evaluated by the Self-Directed Learning Rating Scale), and the satisfaction survey on the quality of teaching; the statistical analyses were performed using t-test or Chi-square test.RESULTS: The scores of theoretical knowledge and case analysis examinations of the case group were significantly higher than those of the control group, and the differences were statistically significant(scores of theoretical knowledge examination: 57.27±2.78 vs 53.91±3.20; scores of case analysis examination: 35.71±3.73 vs 32.67±5.52, both P<0.05). The scores of the Self-Directed Learning Rating Scale of the case group were significantly higher than those of the control group(P<0.05), and the satisfaction with teaching quality of the case group was significantly higher than that of the control group(P<0.05).CONCLUSION: VR-enabled teaching of ocular trauma can effectively improve medical students' mastery of theoretical knowledge and practical skills, enhance students' self-directed learning ability and improve teaching satisfaction.

Objective:To analyze the optical coherence tomography (OCT) imaging characteristics in patients with Coats disease and their value in predicting macular fibrosis.Methods:A nested case-control study was performed.A total of 43 patients (43 eyes) diagnosed with Coats disease through color fundus photography, ocular B-scan ultrasonography, fundus fluorescein angiography, and spectral-domain OCT examination were enrolled from January 2008 to October 2021 at the Xijing Hospital.Among them, there were 40 males and 3 females, aged from 2 to 60 years old, with a median age of 13 years.Macular fibrosis was used as an indicator of poor prognosis, and patients were divided into two groups based on whether macular fibrosis occurred at the end of follow-up.The differences in OCT characteristics between two groups were compared and logistic regression analysis was used to identify the risk factors for macular fibrosis.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Xijing Hospital of Fourth Military Medical University (No.KY20202009-C-1).Results:The OCT clinical features of 43 cases of Coats disease included intraretinal hard exudates in 43 eyes (100%), subretinal fluid in 21 eyes (48.8%), macular cysts in 17 eyes (27.9%), subretinal exudates in 9 eyes (20.9%), anterior retinal hyperreflective dots in 7 eyes (16.3%), epiretinal membrane in 21 eyes (48.8%), and intraretinal fluid in 22 eyes (51.2%).In color fundus photos of 41 eyes, 38 eyes (93.0%) had hard exudates distributed in the posterior pole and 27 eyes (65.9%) had the mid-peripheral region.OCT examination showed that hard exudates were distributed in the inner nuclear layer in 35 eyes (81.4%) and the outer nuclear layer in 33 eyes (76.7%).Among 21 eyes with exudative retinal detachment detected by OCT, 9 eyes (42.9%) were detected by fundus photography and 18 eyes (85.7%) were detected by B-scan ultrasonography.The proportions of eyes with subretinal fluid and subretinal exudates were higher in the macular fibrosis group than in the non-macular fibrosis group, and the differences were statistically significant ( χ2=20.755, P<0.001; χ2=6.133, P=0.013).Logistic regression analysis showed that the presence of subretinal fluid was a risk factor for macular fibrosis (odds ratio=48.345, 95% confidence interval: 4.272-547.066, P=0.002). Conclusions:OCT examination can detect subretinal fluid, subretinal exudates, macular cysts, macular exudates, and hyperreflective spots in the retina of patients with Coats disease.Subretinal fluid is a risk factor for macular fibrosis.

Objective:To observe the efficacy of apatinib combined with first-line chemotherapy and maintenance therapy of only apatinib in patients with extensive small-cell lung cancer.Methods:The clinical data of 56 newly diagnosed patients with extensive small-cell lung cancer in the Fifth People′s Hospital of Dalian City from January 2018 to June 2019 were retrospectively analyzed. Among them, 27 patients (experimental group) were treated with first-line chemotherapy combined with apatinib, and 29 patients (control group) were treated with first-line chemotherapy alone. In experimental group, the expression levels of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR)-2 1 day before chemotherapy and 1 day after chemotherapy were detected by enzyme linked immunosorbent assay method. Response evaluation criteria in solid tumor (RECIST) was used to evaluate the efficacy. The occurrence of adverse reaction was recorded. The patients were followed up for 12 to 24 months, and progression-free survival and 1-year survival were recorded.Results:The objective response rate, median progression-free survival time and 1-year survival rate in experimental group were significantly higher than those in control group: 81.5% (22/27) vs. 55.2% (16/29), 10.5 months vs. 8.5 months and 81.5% (22/27) vs. 55.2% (16/29), and there were statistical differences ( P<0.05); there was no statistical difference in disease control rate between 2 groups ( P>0.05). In experimental group, the patients with complete response and partial response after chemotherapy were classified as effective subgroup (22 cases), and the patients with stationary disease and progressive disease were classified as ineffective subgroup (5 cases). There were no statistical difference in VEGF and VEGFR-2 before chemotherapy between 2 subgroups ( P>0.05). The VEGF and VEGFR-2 in effective subgroup were significantly lower than those in ineffective subgroup: (275.34 ± 16.15) ng/L vs. (330.24 ± 23.21) ng/L and (89.35 ± 4.34) ng/L vs. (112.34 ± 5.45) ng/L, and there were statistical differences ( P<0.01). There were no uncontrollable adverse reactions in 2 groups, and there was no statistical difference in the incidence of adverse reactions between 2 groups ( P>0.05). Conclusions:Application of apatinib in first-line therapy and maintenance therapy for patients with extensive small-cell lung cancer can improve clinical efficacy and survival benefit with controllable adverse reactions.

Objective:To investigate the effect of pidotimod in reducing pulmonary infection in patients with lung cancer undergoing chemotherapy.Methods:One hundred and twenty patients with lung cancer in the Fifth People′s Hospital of Dalian City from July 2017 to July 2018 were selected. The patients were divided into control group and pidotimod group by random digits table method with 60 cases each. The patients were treated with standard two drugs chemotherapy containing platinum drug according to the pathological type, and the patients in pidotimod group were combined with pidotimod. The number of pulmonary infections during chemotherapy, number of completed scheduled chemotherapy and adverse reaction were observed. The correlation between pulmonary infection and pidotimod was analyzed by multivariate orderly Logistic regression.Results:The incidence of pulmonary infection in pidotimod group was significantly lower than that in control group: 18.33% (11/60) vs. 40.00% (24/60), and there was statistical difference ( χ2 = 6.845, P<0.01). The rate of completed scheduled chemotherapy in pidotimod group was significantly higher than that in control group: 55.00% (33/60) vs. 36.67% (22/60), and there was statistical difference ( χ2 = 4.062, P<0.05). Multivariate orderly Logistic regression analysis result showed that pidotimod could reduce the risk of pulmonary infection ( OR = 0.210, 95% CI 0.072 to 0.606, P = 0.004), and help to complete the scheduled chemotherapy ( OR = 2.323, 95% CI 1.080 to 5.003, P = 0.031). In pidotimod group, no obvious adverse reaction related to pidotimod application was detected, and chemotherapy was not affected. Conclusions:Application of pidotimod can reduce the chance of pulmonary infection in patients with lung cancer undergoing chemotherapy and help patients complete scheduled chemotherapy.

Objective To investigate whether vascular endothelial cells in choroidal neovascularization whether hypoxia condition can up-regulate SNAI1 and activate matrix metalloproteinase (MMP)2 and MMP9 therefore to participate in choroidal neovascularization(CNV).Methods Sixteen SPF male C57 mice aged 6-8 weeks were divided into control group and model group.CNV models were induced by retinal laser photocoagulation,and flatmount and frozen sections of retinal pigment epithelium (RPE)-choroid-sclera compound were prepared at 7 days after modeling.The CNV in flat-mount was examined by Isolectin B4 staining,and the location of SNAI1,MMP2 and MMP9 in frozen sections was determined by immunofluorescence technology.The expression of SNAI1,MMP2 and MMP9 at mRNA level in CNV was detected by real-time fluorescence quantitative PCR (real-time PCR).The use and care of experimental animals complied with Statement for the Use of Animals in Ophthalmic and Visual Research.The RF/6A cells were divided into normoxia group and hypoxia group and cultured for 24 hours in 5％ CO2condition and mix condition of 94％ N2,5％ CO2 and 1％ O2,respectively.The expression of SNAI1,MMP2 and MMP9 in the cells at mRNA and protein levels was detected by real-time PCR and Western blot assay,respectively.Small interfering RNA of SNAI1 (siSNAI1) was transfected into the cells,and then the expression of MMP2 in the cells at mRNA and protein levels was detected by real-time PCR and Western blot assay,respectively,and the migrating number of the cells was assayed by Transwell chamber assay.Results CD31 and SNAI1 positive-response cells were seen in RPE-choroid-sclera flat-mounts under the laser scanning confocal microscope.The relative expression levels of SNAI1mRNA and MMP2 mRNA in RPE-choroid-sclera tissues were higher in the model group than those in the control group (SNAI1 mRNA:1.291 ±0.060 vs.0.759±0.074,P =0.001;MMP2 mRNA:1.610±0.424 vs.0.772 ±0.080,P =0.044).The expression of MMP9 mRNA was not significantly elevated between model group and control group (P＞0.05).The relative expression level of MMP2 mRNA was higher in comparison with MMP9 mRNA in the model group (P＜0.01).The relative expressions of hypoxic induced factor 1α (HIF-1α),SNAI1 and MMP2 at mRNA level and protein level in RF/6A cells were significantly higher in the hypoxia group than those in the normoxia group (all at P＜0.05) and no considerable difference was seen in MMP9 mRNA expression between the two groups (P＞0.05).The relative expressions of MMP2 mRNA in the cells were 0.217±0.036 and 0.818±0.105,and those of MMP2 protein in the cells were 0.236±0.009 and 1.043±0.120 in the hypoxia+siSNAI1 group and only hypoxia group,respectively,with significant differences between them (P =0.002,0.003).The migrating number of the cells was (254.60 ±71.31)/field in the hypoxia+siSNAI1 group,which was significantly less than (534.10±96.21) /field in the control group (P =0.029).Conclusions The hypoxic environment at CNV can activate MMP2 by up-regulating the expression of SNAI1,which promotes the migration of vascular endothelial cells and therefore participates in CNV formation,and the intervention of SNAI1 activation under the hypoxic condition can inhibit this process.

Objective To study the operational techniques and feasibility of superior rectal artery preserving laparoscopic resection of sigmoid colon carcinoma.Methods From Jan 2015 to Nov 2016,85 patients with sigmoid colon carcinoma were divided into artery preserving group (27 cases) and traditional surgical group (58 cases).Results The mean operation time was (283 ± 51) min,the mean lymph node dissection was (15 ± 8) and the mean blood loss was (62 ± 17) ml in the artery preserving group.The mean operation time was (179 ±e63) min,the mean lymph node dissection was (15 ±7) and the mean blood loss was (67 ± 17) ml in the traditional surgery group.The number of resected lymph nodes and blood loss had no statistical significance between these two groups (t =0.058,P ＞0.05).Longer operating time were observed in the retained vascular group as compared to the traditional surgical group (t =7.530,P ＜ 0.05).There was no anastomotic fistula in the retained vascular group,however,two anastomotic fistula cases occurred in the traditional surgical group (x2 =0.043,P ＞ 0.05).Conclusions Preservation of superior rectal artery was safe and feasible for laparoscopic resection of sigmoid colon carcinoma.

Background and purpose:A non-recurrent course is a rare anatomic variation of the recurrent laryngeal nerve, which is highly predisposed to injury in thyroidectomy. The study was to summarize preoperative judgment and injury prevention of non-recurrent laryngeal nerve (NRLN) during thyroidectomy.Methods:Preoperative diagnosis and precautions during thyroidectomy were investigated, clinical data from eleven cases of NRLN were analyzed and related literature was reviewed as well.Results:All eleven cases were NRLN of type 1. Among those, the right subclavian artery was found posteriorly to the trachea and esophagus shown by preoperative CT in seven cases. One case who had NRLN injury underwent nerve anastomosis.Conclusion:NRLN is a rare anatomical variation. Preoperative neck CT scan identifies presence of a NRLN, which may reduce the incidence of nerve injures by using intraoperative capsular dissection.

OBJECTIVETo investigate the predictive value of serum CA125 in peritoneal metastasis, and to examine the association of CA125 with the prognosis.

METHODSClinical data of 1285 gastric cancer patients admitted to the Qilu Hospital from March 2003 to September 2008 were retrospectively reviewed. The sensitivity, specificity and accuracy of serum CA125 for peritoneal metastasis were analyzed. Clinicopathological characteristics and survival were compared between patients with normal serum CA125 level(≤35 μg/L) and patients with elevated serum CA125 level(>35 μg/L).

RESULTSThe specificity, sensitivity and accuracy of serum CA125 for peritoneal metastasis were 96.0%, 13.8% and 81.2%, respectively. A significantly higher incidence of peritoneal metastasis was observed in the patients with elevated serum CA125 level as compared to those with normal serum CA125 level(43.2% vs. 16.5%). CA125 was an independent predictor of peritoneal metastasis(RR=3.475, 95% CI:2.124-5.685). The 5-year overall survival rate in patients with elevated serum CA125 level was 13.5%, which was significantly lower than that of patients with normal serum CA125 level (49.8%, P<0.01). CA125 was an independent prognostic factor of gastric cancers(HR=2.049, 95%CI:1.355-2.873).

CONCLUSIONSerum CA125 is useful in predicting peritoneal metastasis and prognosis of gastric cancer, which should be used as a routine examination of gastric cancer patients.

CA-125 Antigen ; blood ; Humans ; Neoplasm Staging ; Peritoneal Neoplasms ; blood ; secondary ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; blood ; pathology ; Survival Rate

Objective To compare the esophageal acid and alkaline exposure characteristics of patients with cardia carcinoma after proximal gastrectomy or total gastrectomy.Method A total of 77 patients of cardia carcinoma who underwent radical resection from Sep 2007 to Sep 2011 in our hospital were retrospectively reviewed.24 hour esophageal pH monitoring were performed in all patients.Result Patients were divided into three groups:group TG had total gastrectomy (n =25),group PP had proximal gastrectomy with pyloroplasty (n =33),group NP had proximal gastrectomy (n =19).It revealed that indicators of acid reflux including the overall time length of acid episodes,＞ 5 min times of acid episodes,duration of longest acid episodes,time length of pH ＜ 4.00 and the DeMeester Scores in group NP were significantly higher than in group PP(U =32,P ＜ 0.01 ; U =35,P ＜ 0.01 ; U =23,P ＜ 0.01 ; U =39,P ＜0.01 ;U =49,P ＜0.01 respectively).Only alkline reflux was observed in group TG.The total times of alkaline episodes in PP group was significantly lower than in group TG(U =52,P ＜0.01) and group NP (U =182,P ＜0.01).＞5 min times of alkaline episodes in group TG was larger than in group PP,and that in group PP was larger than in group NP(P ＜0.01).Duration of longest alkaline episodes and total period of pH ＞7.00 in group PP was significantly higher than in group TG(U =125,P ＜ 0.01 ; U =143.5,P ＜ 0.01),and that in group TG was higher than in group NP(U =23.5,P ＜ 0.01 ; U =14,P ＜ 0.01).Conclusions Alkaline reflux deserves more attention in evaluating esophageal reflux in patients with cardia carcinoma after resection.Pyloroplasty is not helpful to relieving esophageal acid episodes while causing severe alkaline reflux.

Objective To investigate the predictive value of serum CA125 in peritoneal metastasis, and to examine the association of CA125 with the prognosis. Methods Clinical data of 1285 gastric cancer patients admitted to the Qilu Hospital from March 2003 to September 2008 were retrospectively reviewed. The sensitivity, specificity and accuracy of serum CA125 for peritoneal metastasis were analyzed. Clinicopathological characteristics and survival were compared between patients with normal serum CA125 level(≤35 μg/L) and patients with elevated serum CA125 level (> 35 μg/L). Results The specificity, sensitivity and accuracy of serum CA125 for peritoneal metastasis were 96.0%, 13.8% and 81.2%, respectively. A significantly higher incidence of peritoneal metastasis was observed in the patients with elevated serum CA125 level as compared to those with normal serum CA125 level (43.2% vs. 16.5%). CA125 was an independent predictor of peritoneal metastasis (RR=3.475, 95% CI:2.124-5.685). The 5-year overall survival rate in patients with elevated serum CA125 level was 13.5%, which was significantly lower than that of patients with normal serum CA125 level (49.8%, P<0.01). CA125 was an independent prognostic factor of gastric cancers (HR=2.049, 95%CI:1.355-2.873). Conclusion Serum CA125 is useful in predicting peritoneal metastasis and prognosis of gastric cancer , which should be used as a routine examination of gastric cancer patients.