AIM: To investigate the influencing factors of corneal edema after phacoemulsification combined with intraocular lens(IOL)implantation in middle-aged and elderly patients with diabetic cataract, reducing postoperative complications of cataract in such patients.METHODS: A total of 198 middle-aged and elderly patients(226 eyes)with diabetic cataract who underwent phacoemulsification combined with IOL implantation in Zhongxian People's Hospital of Chongqing from August 2021 to June 2023 were retrospectively analyzed, and they were divided into corneal edema group(n=53)and non-corneal edema group(n=173)according to their postoperative corneal edema. Baseline data were collected and compared between the two groups, and the operation-related indexes such as preoperative corneal thickness, endothelial cell density, operation time and effective phaco time were recorded and compared between the two groups. The influencing factors of corneal edema were analyzed by multivariate Logistic model, and the risk nomogram was drawn.RESULTS: The age distribution of patients ≥60 years old in the corneal edema group was significantly higher than that in the non-corneal edema group, the duration of diabetes mellitus in the corneal edema group was significantly longer than that in the non-corneal edema group, and the lens nuclear hardness grade was significantly higher than that in the non-corneal edema group(all P<0.05). The changes in endothelial cell density in the corneal edema group were significantly higher than those in the non-corneal edema group(P<0.05); compared with the non-corneal edema group, the patients in the corneal edema group had a longer operation time and a longer effective phaco time(all P<0.05). Age, duration of diabetes mellitus, lens nuclear stiffness grade, operation time and effective phaco time were the risk factors for corneal edema after surgery(all P<0.05). When the total score of the patient risk nomogram is 150 points, the risk of corneal edema after surgery is about 65%.CONCLUSION: The factors influencing the occurrence of corneal edema after phacoemulsification combined with IOL implantation include age, duration of diabetes, lens nuclear stiffness, operation duration and effective phaco time.

Objective:To analyze the prevalence and distribution characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in hospitalized patients with thoracic ossification of the ligamentum flavum (TOLF).Methods:The clinical records of 132 consecutive TOLF patients from January 2018 to June 2019 were retrospectively studied. DISH was identified by the preoperative X-ray and CT and its prevalence was calculated. The prevalence of patients with different genders, different age groups and different ossification types was compared. The segmental distribution of DISH and the distribution in the upper (T 1-T 4), middle (T 5-T 8), and lower thoracic spine (T 9-T 12) were analyzed. Ossification degree of DISH was evaluated based on the Meta scoring system. The demographic characteristics (age, gender, BMI, etc.) were compared between DISH and non-DISH group. Results:Forty-nine patients was diagnosed as DISH with the prevalence of 37.1% in all included cases. The prevalence was about twice as high in male (46.3%) than in female (23.1%) ( χ2=8.806, P=0.003). The prevalence in the age groups of <40, 40-49, 50-59, 60-69 and ≥70 years was 20.0%, 28.0%, 34.4%, 44.0%, and 66.7%, respectively. The prevalence in long-segment TOLF patients (45.1%) was significantly higher than that in short-segment TOLF patients (24.0%) ( χ2=5.937, P=0.015). DISH most frequently affected T 8,9 levels (91.8%). The total number and mean number of ossified segments were 365 and 7.4, respectively. Ossification lesions in the upper, middle, lower thoracic spine accounted for 26.03%, 40.54%, and 33.15%, respectively. Grade I, grade II, and grade III ossification accounted for 21.4%, 28.5% and 50.1%, respectively. The mean age of the DISH group was older than the non-DISH group ( t=2.024, P=0.045). The proportion of male patients in the DISH group was significantly higher than that in the non-DISH group ( χ2=8.806, P=0.003). The average height and weight in the DISH group were significantly greater than those in the non-DISH group ( t=2.564, P=0.012; t=2.191, P=0.030), whereas no significant differences in BMI and constituent ratio of concurrent diabetes, cardiac disease, hypertension between two groups were observed. Conclusion:The prevalence of DISH in patients with TOLF is 37.1%. Male, elderly and long-segment TOLF patients are associated with higher prevalence. DISH frequently occurs in the middle and lower thoracic spine, and T 8,9 is the common affected segment. Ossification lesions may develop with age. Demographic characteristics of DISH group differ, to some extent, from those of non-DISH group.

ObjectiveTo explore the predictive role of the degree of prospective memory impairment on the treatment response to Selective Serotonin Reuptake Inhibitors （SSRIs） in patients with obsessive-compulsive disorder. MethodsA total of 30 patients with obsessive-compulsive disorder who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fourth edition， text revision （DSM-IV-TR） were selected， and all patients were treated with SSRIs for 4 weeks. The severity of obsessive-compulsive symptom was assessed using Yale-Brown Obsessive Compulsive Scale （Y-BOCS）， and the efficacy was evaluated by the reduction rate of Y-BOCS score. Moreover， the performance of event-based， time-based and activity-based prospective memory tasks were compared before and after treatment. ResultsAfter treatment， the total Y-BOCS score of patients was lower than before treatment ［（27.07±4.63） vs. （24.87±5.93）， F（1，29）=4.984， P=0.033］， meantime， the performance of event- and time- based prospective memory tasks was improved ［（0.78±0.21） vs. （0.88±0.11）， F（1，29）=9.022， P=0.005； （0.81±0.17） vs. （0.91±0.11）， F（1，29）=9.063， P=0.005］. Correlation analysis showed that the performance of event-based prospective memory at baseline was positively correlated with the reduction of Y-BOCS score （r=0.478， P=0.014）. The event-based prospective memory performance at baseline could positively predict the treatment response to SSRIs treatment in patients （β=0.441， P=0.014）. ConclusionThe event-based prospective memory function of patients with obsessive-compulsive disorder can positively predict SSRIs treatment outcome， and patients with better prospective memory performance yield better treatment responses.

ObjectiveTo study the prospective memory deficits of obsessive-compulsive disorder patients and unaffected first-degree relatives of patients， so as to validate the possibility of prospective memory as an endophenotype of obsessive-compulsive disorder. MethodsHealthy controls， obsessive-compulsive disorder patients and unaffected first-degree relatives of patients， each with 25 cases， matched for age， education， gender， IQ and marriage status were enrolled. The standardized prospective memory paradigm with a multi-trial design was conducted， and the accuracy was used as an indicator of prospective memory function. ResultsThe accuracy of event- and time-based prospective memory tasks of obsessive-compulsive disorder patients was lower than that of healthy controls， with statistical differences ［（0.74±0.24） vs. （0.88±0.13）， d=-0.140， P=0.044； （0.77±0.21） vs. （0.93±0.10）， d=-0.164， P=0.011］. The accuracy of event-based prospective memory task of unaffected first-degree relatives was also lower than that of healthy controls， with statistical difference ［（0.73±0.20） vs. （0.88±0.13）， d=-0.144， P=0.036］. ConclusionObsessive-compulsive disorder patients has extensive prospective memory deficits， indicating that prospective memory may be an endophenotype of obsessive-compulsive disorder.

Distal junctional problem (DJP) is one of the severe complications after spinal correction, fixation and fusion. As the number of patients receiving spinal surgery increased recently, the incidence of DJP also increased dramatically. Compared with proximal junctional problem, the incidence of DJP is low. However, the clinical symptoms are severe, and the rate of surgical revision is high in patients with distal junctional problems. DJP include distal junctional kyphosis (DJK) and distal junctional failure(DJF). The definition of DJK is confusing, however, and the most commonly used was that the distal junction Angle at the last follow-up was greater than 10° and increased by 10° compared with that before surgery. There are 6 DJF modes: progressive loss of lumbar lordosis,acute wedging in the disc below the instrumentation, fracture of LIV, osteoporotic fracture below the long rigid fixation, failure of the instrumentation at LIV, spinal stenosis and or segmental instability underneath the instrumentation. Possible risk factors for DJP include weight, age, type of spinal deformity, osteoporosis, choice of LIV, hip disease, deformity location, surgical approach, surgical procedure, fusion segments, fixation devices, LIV at L5, fixed to S1 with no iliac screws, poor restoration of spinal alignment, et al. Currently, there are some controversies in DJP, mainly including the incidence, risk factors whether needs to and how to revise. The review intends to conduct a simple literature review of the current DJP diagnostic criteria, incidence, risk factors, and other research progress, in order to improve the understanding of the distal junction problem.

Thoracic ossification of ligament flavum (TOLF) is a pathological process of heterotopic bone formation from ligamentum flavum tissue, which is the most common cause of thoracic spinal stenosis and thoracic myelopathy. Imaging examination is the predominant measure for localization and qualitative diagnosis for TOLF. Various TOLF classification systems have been reported currently, based on its morphology, distribution, configuration of compressed spinal cord or its association with peripheral tissue structures. However, there has been no unified classification due to confusing clinical applications. Therefore, we conducted a review to summarize TOLF classification systems and to evaluate the reliability of these classification systems and the diagnostic accuracy of various imaging modalities. As demonstrated in literatures, the diagnostic accuracy of radiography and the reliability of related classification were low. CT-based Sato classification (lateral, extended, enlarged, fused, tuberous) and Kuh classification (unilateral, bilateral, bridging), MRI-based Kuh classification (round, beak) and Chen Zhongqiang classification (isolated, skipping, continuous), Muthukumar classification combined with dural ossification (Tram track sign, Comma sign) elaborated ossification characteristics from different angles and dimensions. These classification systems were clinically significant in pathogenesis implication, risk assessment, treatment guidance and prognosis judgement, which showed high diagnostic accuracy and reliability. Combining multi-dimension and multi-level parameters of CT and MRI will play an important role in the diagnosis, treatment and new classification research of TOLF.

Ossification of posterior longitudinal ligament (OPLL) and ossification of ligamentum flavum (OLF) are clinically common heterotopic ossification diseases, which are the main causes of cervical and thoracic spinal stenosis and spinal cord injury. In some cases, OPLL and OLF may involve multiple spinal sites, individually or concurrently, increasing the difficulty of clinical diagnosis and treatment. This review initially attempts to define this specific ossification phenomenon as Tandem ossification of intraspinal ligaments (TOIL). It refers to a kind of severe spinal ligament ossification diseases caused by multiple factors, that OPLL and OLF occur alone or in combination at two or more sites of the cervical, thoracic, or lumbar spine with five or more ossified segments, progressively compressing the spinal cord or nerves, thereby resulting in a series of complex clinical symptoms. The prevalence of TOIL remains unknown, but its clinical detection rate is relatively high, and the most common TOIL is cervical OPLL combined with thoracic OPLL or/and OLF. Moreover, occurrence and development of TOIL involve many factors and its definitepathogenesis is not clear. Damage of upper and lower motor neurons can occur simultaneously in TOIL patients so that their clinical symptoms and signs often interfere with each other. TOIL has various forms, complex imaging features, and no uniform diagnostic and localization diagnostic criteria, which may easily lead to missed diagnosis and misdiagnosis. It is recommended that TOIL is identified by the typical symptoms and signs as the basis, CT three-dimensional reconstruction and MRI signs as the reference, and combination of the possible risk factors and clinical experience. Currently, surgical decompression for responsible lesions is the only effective treatment for symptomatic TOIL. However, domestic and foreign scholars still have great arguments on the optimal surgical strategy of TOIL. No consensus has been reached on how to determine the operating segment and the extent of decompression, which surgical approach and technique to be adopted, and when to select staged or one-stage combined surgery. Therefore, this review summarizes and discusses the current status and progress of the clinical characteristics and surgical strategies of TOIL through searching the relevant literature, to provide a reference for clinicians to diagnose and treat TOIL.

Objective To estimate effective and organ doses to prostate cancer patients result ing from the whole-body 18F-Choline,11C-Choline and 68Ga-PSMA PET-CT examinations.Methods A total of 150 prostate cancer patients who underwent PET-CT scanning from May 2017 to June 2018 were retrospectively analyzed.They were divided into three groups,each with 50 patients,according to the type of positron radiopharmaceuticals injected.All patients used the same PET-CT scan protocol.PET component dose was calculated by using OLINDA/EXM (version 1.1) software which was based on the MIRD method.The CTDI values were measured by the standard CT phantoms and computed by ImPACT (version 1.0.4) CT,and ImPACT was used for dose calculation from CT.The tissue weighting factors according to ICRP Report 103 were used for effective dose calculation.Results The effective dose and organ equivalent dose from 18F/11C-Choline and 68Ga-PSMA PET/CT examinations were estimated.The voltage and current of Topogram scan were 120 kV and 35 mA,respectively,as well as 120 kV and (135.6±9.4) mA for low-dose CT scan.The injected activity of 18 F-Choline,11 C-Choline and68Ga-PSMA was (279.2±13.2),(350.2±39.9) and (186.8±19.4) MBq,respectively.The effective dose was (5.0±0.2),(1.6±0.2) and (3.0±0.3) mSv,respectively (F=837.0,P＜0.001).The CT effective dose was (11.4±0.2) mSv.The total effective dose for three groups were (16.4±0.3),(13.0±0.3) and (14.4±0.4) mSv,respectively.The mean organ equivalent doses were statistically significantly different among groups (F=381.2-1 637.7,P＜0.001).The highest organ equivalent dose was to kidney for18F-Choline and68 Ga-PSMA PET/CT scans and thyroid for11 C-Choline PET/CT scan.Conclusions The effective dose to the prostate cancer patients who underwent PET-CT scanning was from 13.0 to 16.4 mSv,with vast majority of these doses coming from CT scans.The lowest radiation dose to the patients was caused by 11C-Choline PET-CT examination,suggesting that it would be a potential prostate cancer PET radiotracer.

Objective To investigate the clinical efficacy of acupuncture at affected-limb gallbladder meridian points and its effect on the recovery of lower limb function in treating hemiplegia patients with cerebral infarction. Methods Sixty hemiplegia patients with cerebral infarction were randomly allocated to treatment and control groups, 30 cases each. The treatment group received acupuncture at the gallbladder meridian points of the affected-side lower limb as main therapy and the control group, conventional acupuncture. After two courses of treatment, a pre-/post-treatment change in the Lower Extremity Fugl-Meyer Assessment score was observed in the two groups and post-treatment walking paces, pace lengths and incidences of strephenopodia were compared between the two groups.Results There was a statistically significant pre-/post-treatment difference in the Lower Extremity Fugl-Meyer Assessment score in the two groups (P<0.01). There was a statistically significant post-treatment difference in the Lower Extremity Fugl-Meyer Assessment score between the treatment and control groups (P<0.05). There were statistically significant post-treatment differences in walking pace, pace length and the incidence of strephenopodia between the treatment and control groups (P<0.05).Conclusion Acupuncture at affected-limb gallbladder meridian points can improve lower limb function and reduce the incidence of strephenopodia in hemiplegia patients with cerebral infarction.

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P<0.05) in both groups, and was lower in the prehabilitation group than in the control group before and six weeks after TKA (t>2.827, P<0.01). There was no significant difference in AROM of knee flexion when enrolling and before TKA in both groups (t<0.648, P>0.05), and it increased in the control group six weeks after TKA (t>3.555, P<0.01), and no increasement was found in the prehabilitation group (t<1.608, P>0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P<0.05). The muscle strength of trunk extention and flexion enhanced before TKA in the prehabilitation group (t>2.387, P<0.05), and no change was found in the control group (t<0.940, P>0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t<1.656, P>0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t<0.350, P>0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P<0.001), there was no significant difference in it between two groups six weeks after TKA (t=-0.497, P=0.622). The score of HSS-KS increased before TKA (t=-2.621, P=0.015) in the prehabilitation group, and no increasement was found in the control group (t=2.073, P=0.053), and they were higher in the prehabilitation group than in the control group before and six weeks after TKA (t>2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.