With the rapid advancement of refractive surgery, small incision lenticule extraction(SMILE)has become a mainstream procedure due to its biomechanical advantage in preserving the integrity of the anterior elastic layer and epithelium. However,postoperative stromal tissue removal and stress redistribution may still compromise corneal biomechanical stability, potentially affecting long-term corneal stability and visual quality. This review focuses on the mechanisms underlying biomechanical changes after SMILE, summarizing recent findings on corneal thinning, reduced mechanical strength, and stress remodeling, and their impact on corneal morphology and visual quality. It further explores potential contributors to postoperative ectasia, increased higher-order aberrations(HOAs), and visual fluctuations, highlighting individual variability and current controversies in the literature. Moreover, current evidence on adjunctive strategies such as corneal cross-linking(CXL)in enhancing biomechanical strength, reducing complications, and improving optical quality was analyzed. Finally, optimal timing for CXL, threshold values of biomechanical metrics, and the role of individualized preoperative assessment and postoperative management was discussed, aiming to provide a theoretical and clinical basis for improving safety and visual outcomes following SMILE.

Due to the advancement of 16S rRNA sequencing technology, the lower respiratory tract microbiota, which was considered non-existent, has been revealed. The correlation between these microorganisms and diseases such as tumor has been a hot topic in recent years. As the bacteria in the surrounding can infiltrate the tumors, researchers have also begun to pay attention to the biological behavior of tumor bacteria and their interaction with tumors. In this review, we present the characteristic of the lower respiratory tract bacteria and summarize recent research findings on the relationship between these microbiota and lung cancer. On top of that, we also summarize the basic feature of bacteria in tumors and focus on the characteristic of the bacteria in lung cancer. The relationship between bacteria in lung cancer and tumor development is also been discussed. Finally, we review the potential clinical applications of bacterial communities in the lower respiratory tract and lung cancer, and summarize key points of sample collection, sequencing, and contamination control, hoping to provide new ideas for the screening and treatment of tumors.
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Humans ; Lung Neoplasms ; RNA, Ribosomal, 16S/genetics* ; Bacteria/genetics* ; Microbiota ; Respiratory System ; Lung/microbiology*

Objective:To further investigate the safety and efficacy of Belimumab in the treatment of patients with systemic lupus erythematosus (SLE).Methods:All SLE patients treated with Belimumab from May 1, 2020 to February 1, 2022 in Peking Union Medical College Hospital were retrospectively collected and analyzed. The clinical manifestations, the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2000) score, and laboratory test such as levels of anti-dsDNA antibody, the medication before and after Belimumab treatment, adverse events were collected. Normally distributed data were tested using the t-test, otherwise the Wilcoxon paired signed rank test was used. Results:A total of 81 patients were enrolled in this study. The use of belimumab could significantly decrease the SLEDAI-2000 score [10.00(7.75, 12.00) vs. 4.00(3.75, 6.00), Z=-5.38, P<0.001], ESR of SLE patients [19.50(12.75, 32.25) mm/1 h vs. 14.00(7.75, 20.25) mm/1 h, Z=-3.71, P=0.003], anti-dsDNA titer detected by CLIFT [300.00 (117.00, 864.00) vs. 183.00(100.00, 471.00), Z=-4.15, P=0.001], meanwhile, increase the complement C3 [0.78 (0.62, 0.97)g/L vs. 0.69 (0.55, 0.84)g/L, Z=-4.68, P<0.001], and the complement C4 [0.12 (0.08, 0.19)g/L vs. 0.10 (0.05, 0.14)g/L, Z=-4.78, P<0.001]. We also observed that with the use of Belimumab, the dosage of Glucocorticoids decreased significantly, which were [10.00(7.50, 22.50) mg vs. 7.50(5.00, 10.00) mg, Z=-4.90, P<0.001]. In addition, the antibody of IgG, IgA and IgM decreased significantly. Only one patient stopped the administration of Belimumab due to the low level of immunoglobulin. Conclusion:Belimumab can alleviate disease activity of patients with SLE and help in safely tapering the daily dose of glucocorticoid with good safety.

Objective:To discuss the clinical efficacy of recombinant human growth hormone(rhGH)in the treatment of the pediatric patients with growth hormone deficiency(GHD)and idiopathic short stature(ISS),and to clarify its clinical application value in the pediatric patients with short stature of different etiologies.Methods:The clinical data of 132 children with short stature who treated with rhGH from January 2018 to January 2023 were collected.They were divided into GHD group(n=70)and ISS group(n=62)based on different etiologies.The bone age,target height(TH),body mass index(BMI),height standard deviation score(HtSDS),changes in height standard deviation scores(ΔHtSDS)before treatment and 6 months after treatment,and growth velocity(GV)of the pediatric patients were calculated.Propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)were used to balance the confounding factors between the pediatric patients in two groups and the efficacy and safety of the pediatric patients in two groups were evaluated.Results:There were significant differences in whether children were full-term,bone age,bone age maturity,and TH of the pediatric patients between two groups(P<0.05).Compared with before treatment,the height and HtSDS of the pediatric patients in both GHD and ISS groups were significantly increased after treated for 6 months(P<0.05).Before matched by PSM,there were significant differences in full-term,bone age,bone age maturity,and TH of the pediatric patients between two groups(P<0.05).After matched by PSM,there were no significant differences in gender,region,term birth status,mode of delivery,feeding method,age,bone age,height,BMI,TH,and pretreatment HtSDS of the pediatric patients between two groups(P>0.05);the standardized mean difference(SMD)differences of covariates except for region were<0.2.After weighted by IPTW,there were no significant differences in gender,region,term birth status,mode of delivery,feeding method,age,bone age,height,BMI,TH,and pretreatment HtSDS of the pediatric patients between two groups(P>0.05);all SMD of covariates except for term birth status were<0.2.Before balancing covariates,after meatched by PSM matching,and after weighted by IPTW weighting compared with GHD group,the GV and ΔHtSDS of the pediatric patients in ISS group were slightly increased,but the difference was not significant(P>0.05).In terms of adverse reactions,2 cases(2.68%)of fasting hyperglycemia and 7 cases(10.00%)of hypothyroidism occurred in GHD group;3 cases(4.84%)of fasting hyperglycemia and 2 cases(3.23%)of hypothyroidism occurred in ISS group.Conclusion:rhGH can promote the height increase in the patients with GHD and ISS,and there is no significant difference in the height-increasing efficacy between GHD and ISS children.The incidence of adverse reactions is relatively low during treatment,indicating good overall safety.

Objective:To analyze the clinical characteristics and risk factors of systemic lupus erythematosus (SLE) with Libman-Sacks endocarditis (LSE).Methods:Data of SLE patients with LSE ( n=20) who admitted in Peking Union Medical College Hospital from January 2012 to May 2021 were retrospectively collected. SLE patients without LSE ( n=60) were randomly selected as controls according to 1∶3 age and sex matched in the hospitalized patients during the same period. Clinical characteristics, laboratory and imaging examinations were analyzed. Data were expressed as Mean± SD, and t test was used to compare quantitative data in normal distri-bution. Data were expressed as M ( Q1, Q 3), and Wilcoxon signed-rank test or Wilcoxon rank sum test were used to compare quantitative data in non-normal distribution. The count data were compared with Chi-square test or Fisher's exact test. Univariate conditional logistic regression was used for univariable analyses. P values less than 0.05 were considered statistically significant. Results:There were 20 SLE patients with LSE, 18 females with an average age of (32±9) years (13 to 49 years). The disease duration of SLE was 16.04(0, 185.1) months when LSE was discovered, and vegetations were located at the mitral valve in 19 (95.0%) patients. Cerebral infarction (45.0% vs 10.0%, χ2=9.87, P=0.001) and antiphospholipid syndrome (APS) (50.0% vs 5.0%, χ2=22.32, P<0.001) were more common in SLE with LSE. In addition, SLE with LSE had lower platelet counts [(140±67)×10 9/L vs (189±115)×10 9/L, t=-2.29, P=0.026] and higher positive rate of lupus anticoagulant (LA) (80.0% vs 23.6%, χ2=19.65, P<0.001), lower positive rate of anti-SSA antibodies (21.1% vs 60.0%, χ2=6.38, P=0.012). Left atrial enlargement (anteroposterior diameter of left atrium>40 mm) was more common in SLE patients with LSE (35.0% vs 5.4%, χ2=9.37, P=0.002), and anteroposterior diameter of left atrium [(37±7) mm vs (33±4) mm, t=2.15, P=0.043] were larger and left ventricular ejection fraction [(63±10)% vs (68±6)%, t=-2.41, P=0.019] was lower. The risk of SLE with LSE complicated with APS was 19 times compared with SLE without LSE [ OR (95% CI)=19.00 (4.43, 81.38), P<0.001]. Conclusion:SLE patients with LSE have increased risk of APS and cerebrovascular diseases. For patients with positive LA, the possibility of LSE should be alerted.

AIM: To observe the clinical effect of posterior chamber phakic refractive lens(PC-PRL)implantation in the treatment of ultra-high myopia.METHODS: Retrospective case study. A total of 36 patients(67 eyes)with ultra-high myopia who underwent PC-PRL implantation in our hospital from January 2021 to January 2022 were selected. They were and divided into two groups according to the preoperative spherical equivalent, with 16 cases(30 eyes)in spherical equivalent ≤-18.00D group and 20 cases(37 eyes)in spherical equivalent >-18.00D group. The preoperative and postoperative visual acuity, intraocular pressure(IOP), corneal endothelial cell density(ECD), central anterior chamber depth(ACD)and postoperative vault and complications were compared and analyzed.RESULTS: The uncorrected visual acuity(UCVA)at 3mo after operation of the two groups reached or exceeded the preoperative best corrected visual acuity(BCVA; all P<0.05), and the spherical equivalent >-18.00D group had a greater visual acuity improvement(P<0.01). There were significant differences in IOP and corneal ECD between the two groups at 1d after operation and before operation(all P<0.05); The vault at different time points decreased after operation, but it was within the normal range; The ACD at 3mo after operation was lower than that before operation(all P<0.01). There was no difference in intraocular pressure, ECD, ACD and postoperative vault between the two groups(P>0.05). No serious postoperative complications occurred in both groups.CONCLUSION: The PC-PRL implantation had improved early visual acuity and stable refractive state, which was safe and reliable, and there were no serious complications in the treatment of patients with ultra-high myopia.

Objective:To understand the current status of social support for patients with oral cancer after surgery, and to explore the correlation between it and the anticipatory grief of the primary caregivers, so as to provide a reference for medical and nursing staff to take effective intervention.Methods:From December 2021 to April 2022, 160 patients with oral cancer and their main caregivers who were admitted to the Head and Neck Cancer Surgery of West China Hospital of Stomatology affiliated to Sichuan University were selected by convenience sampling. The subjects were investigated with the General Information Questionnaire, Social Support Rating Scale (SSRS) and Anticipatory Grief Scale (AGS) . Pearson correlation analysis was used to explore the correlation between the social support of patients with oral cancer after surgery and the anticipatory grief of their main caregivers. Multiple linear regression was used to analyze the influencing factors of social support of patients with oral cancer after surgery. A total of 160 questionnaires were issued, 159 of which were valid, and the valid recovery rate was 99.4% (159/160) .Results:Among 159 patients with oral cancer after surgery, the total score of SSRS was (37.43±7.99) , and the average score of items was (3.74±0.80) . Among 159 primary caregivers, the total score of AGS was (70.60±15.90) , and the average score of items was (2.62±0.59) . Pearson correlation analysis showed that the total score of SSRS in oral cancer patients was negatively correlated with the total score of AGS in their primary caregivers ( P<0.01) . Multiple linear regression analysis showed that the primary caregivers' anticipatory grief of caregivers with oral cancer after surgery was the influencing factor of the patients social support ( P<0.05) , which could independently explain 11.2% of the variation ( P<0.01) . Conclusions:The social support of patients with oral cancer after surgery is at a medium and above level, and the anticipatory grief of their main caregivers is at a medium level. The anticipatory grief of caregivers with oral cancer after surgery is the influencing factor of social support of the patients. Clinical medical and nursing staff should pay more attention to the psychological state of patients and their main caregivers, improve the social support of patients.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Lung cancer is the most frequent cancer and the leading cause of cancer death all around the world. Anti-programmed cell death 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) therapies have significantly improved the outcomes of non-small cell lung cancer (NSCLC) patients in recent years. However, the objective response rate in non-screened patients is only about 20%. It is very important to screen out the potential patients suitable for immunotherapy. Immunohistochemical staining of tumor tissue biopsies with PD-L1 antibodies can predict the therapeutic response to immunotherapy to some extent, but it still has some limitations. Recently some clinical studies have shown that PD-L1 expression in circulating tumor cells (CTC-PD-L1) is a potential independent biomarker and may provide important information for immunotherapy in NSCLC. This article will review technology for CTC-PD-L1 detection and the predictive value of CTC-PD-L1 for immunotherapy in NSCLC and review the latest clinical research progress.

AIM: To investigate dynamic changes of posterior corneal power and astigmatism after cataract surgery based on Pentacam three-dimensional anterior eye segment analyzer.

METHODS: Totally 96 elderly patients(116 eyes)with cataract underwent phacoemulsification combined with intraocular lens implantation in our hospital from January 2019 to January 2020 were selected. Parameters including anterior corneal power, posterior corneal power, flat keratometry, steep keratometry, mean keratometry, anterior corneal astigmatism, posterior corneal astigmatism, and total corneal astigmatism were obtained using Pentacam three-dimensional anterior eye segment analyzer system at postoperative 1wk, 1mo and 3mo. Spearan correlation analysis was performed on the anterior segment.

RESULTS: The anterior corneal power(flat keratometry, steep keratometry, mean keratometry)was lower at postoperative 1wk than that before operation, and began to return to the preoperative level at postoperative 1mo and 3mo. The posterior corneal power and total corneal power(flat keratometry, steep keratometry, mean keratometry)were higher at postoperative 1wk than before operation, and began to stabilize at postoperative 3mo. The anterior corneal astigmatism, posterior corneal astigmatism, and total corneal astigmatism were also higher at postoperative 1wk than before operation, and began to decrease and stabilize at postoperative 3mo. The anterior corneal power was significantly positively correlated with total corneal power; The posterior corneal power was significantly negatively correlated with the total corneal power, and was significantly positively correlated with its absolute value(P<0.05). The total corneal astigmatism before operation and at postoperative 1wk and 3mo was significantly positively correlated with anterior corneal astigmatism at corresponding time points(P<0.01), while showed no significant correlation with posterior corneal astigmatism.

CONCLUSION: Changes of posterior corneal power and astigmatism can be observed with 3mo of cataract surgery, and Pentacam three-dimensional anterior eye segment analyzer system can accurately assess the dynamic changes of anterior and posterior corneal power and astigmatism before and after operation, which is of great clinical value.