AIM:To compare and analyze the effectiveness and safety of reducing the diameter of the back optical zone diameter(BOZD)of orthokeratology lens designed by CRT and VST in controlling the progression of myopia in children and adolescents.METHODS:Retrospective study. The study subjects were 400 myopia patients aged 8-16 years who were admitted to the orthokeratology fitting center of our hospital from June 2019 to May 2022, with 400 eyes(including right eye data analysis). The subjects were divided into CRT-S group(BOZD<6.0 mm), CRT group(BOZD=6.0 mm), VST-S group(BOZD<6.2 mm), VST group(BOZD=6.2 mm)according to the brand of orthokeratology lens and BOZD group, with 100 cases in each group. Uncorrected visual acuity(UCVA), corneal flat K value, axial length, spherical equivalent, and incidence of corneal injury were collected and analyzed at 1 d, 1 wk, 1 and 6 mo, 1 and 2 a, respectively.RESULTS:After wearing lenses for 1 d, the UCVA of the VST-S group improved the fastest, but after 1 wk, all groups reached a good UCVA, and there was no significant difference between groups. The corneal flat K value of the CRT-S group decreased the most after wearing lenses for 6 mo, and there was no significant difference in the corneal flat K value of all groups after 1 year of lens wearing. At each time point, the axial length growth decreased significantly after reducing the BOZD of the same brand of orthokeratology lens. At 6 mo, there was no significant difference in the axial length growth and defocus ring diameter between the CRT-S group and the VST-S group, but at 1 and 2 a, the VST-S group had significantly lower axial length growth and defocus ring diameter than the CRT-S group. The growth of the diopter sphere and spherical equivalent(SE)was significantly reduced when the BOZD of the same brand of orthokeratology lens was reduced at 2 a follow-up. The VST-S group had the smallest changes in the degree of SE and had the best myopia control effect. There was no significant difference in the change value of the diopter cylinder and the incidence of corneal injury among the four groups.CONCLUSION:Reducing the BOZD of the orthokeratology lens can effectively control the growth of the axial length and the progression of myopia degree. The myopia control effect of the VST lens is better than that of the CRT lens after reducing the BOZD. Reducing the BOZD of the orthokeratology lens does not increase the risk of additional corneal injury.

AIM:To compare and analyze the effectiveness and safety of reducing the diameter of the back optical zone diameter(BOZD)of orthokeratology lens designed by CRT and VST in controlling the progression of myopia in children and adolescents.METHODS:Retrospective study. The study subjects were 400 myopia patients aged 8-16 years who were admitted to the orthokeratology fitting center of our hospital from June 2019 to May 2022, with 400 eyes(including right eye data analysis). The subjects were divided into CRT-S group(BOZD<6.0 mm), CRT group(BOZD=6.0 mm), VST-S group(BOZD<6.2 mm), VST group(BOZD=6.2 mm)according to the brand of orthokeratology lens and BOZD group, with 100 cases in each group. Uncorrected visual acuity(UCVA), corneal flat K value, axial length, spherical equivalent, and incidence of corneal injury were collected and analyzed at 1 d, 1 wk, 1 and 6 mo, 1 and 2 a, respectively.RESULTS:After wearing lenses for 1 d, the UCVA of the VST-S group improved the fastest, but after 1 wk, all groups reached a good UCVA, and there was no significant difference between groups. The corneal flat K value of the CRT-S group decreased the most after wearing lenses for 6 mo, and there was no significant difference in the corneal flat K value of all groups after 1 year of lens wearing. At each time point, the axial length growth decreased significantly after reducing the BOZD of the same brand of orthokeratology lens. At 6 mo, there was no significant difference in the axial length growth and defocus ring diameter between the CRT-S group and the VST-S group, but at 1 and 2 a, the VST-S group had significantly lower axial length growth and defocus ring diameter than the CRT-S group. The growth of the diopter sphere and spherical equivalent(SE)was significantly reduced when the BOZD of the same brand of orthokeratology lens was reduced at 2 a follow-up. The VST-S group had the smallest changes in the degree of SE and had the best myopia control effect. There was no significant difference in the change value of the diopter cylinder and the incidence of corneal injury among the four groups.CONCLUSION:Reducing the BOZD of the orthokeratology lens can effectively control the growth of the axial length and the progression of myopia degree. The myopia control effect of the VST lens is better than that of the CRT lens after reducing the BOZD. Reducing the BOZD of the orthokeratology lens does not increase the risk of additional corneal injury.

With the increasing use of plastics worldwide, the amount of plastic waste being discarded has also risen. This plastic waste undergoes physical and chemical processes, breaking down into smaller particles known as microplastics (MPs) or nanoplastics (NPs). Advances in technology have enhanced our ability to detect these smaller particles, and it has been confirmed that plastics can be found in marine organisms as well as within the human body. However, research on the effects of MPs or NPs on living organisms has only recently been started, and our understanding remains limited. Studies on the immunological impacts are still ongoing, revealing that MPs and NPs can differentially affect various immune cells based on the material, size, and shape of the plastic particles. In this review, we aim to provide a comprehensive understanding of the effects of MPs and NPs on the immune system. We will also explore the methods for plastic removal through physicochemical, microbial, or biological means.

With the increasing use of plastics worldwide, the amount of plastic waste being discarded has also risen. This plastic waste undergoes physical and chemical processes, breaking down into smaller particles known as microplastics (MPs) or nanoplastics (NPs). Advances in technology have enhanced our ability to detect these smaller particles, and it has been confirmed that plastics can be found in marine organisms as well as within the human body. However, research on the effects of MPs or NPs on living organisms has only recently been started, and our understanding remains limited. Studies on the immunological impacts are still ongoing, revealing that MPs and NPs can differentially affect various immune cells based on the material, size, and shape of the plastic particles. In this review, we aim to provide a comprehensive understanding of the effects of MPs and NPs on the immune system. We will also explore the methods for plastic removal through physicochemical, microbial, or biological means.

With the increasing use of plastics worldwide, the amount of plastic waste being discarded has also risen. This plastic waste undergoes physical and chemical processes, breaking down into smaller particles known as microplastics (MPs) or nanoplastics (NPs). Advances in technology have enhanced our ability to detect these smaller particles, and it has been confirmed that plastics can be found in marine organisms as well as within the human body. However, research on the effects of MPs or NPs on living organisms has only recently been started, and our understanding remains limited. Studies on the immunological impacts are still ongoing, revealing that MPs and NPs can differentially affect various immune cells based on the material, size, and shape of the plastic particles. In this review, we aim to provide a comprehensive understanding of the effects of MPs and NPs on the immune system. We will also explore the methods for plastic removal through physicochemical, microbial, or biological means.

ObjectiveTo investigate the pharmacodynamic effects of Houshihei San （HSHS） recorded with the effects of treating wind and limb heaviness on muscle tissue injury after middle cerebral artery occlusion （MCAO） in rats through the ferroptosis pathway. MethodsThirty SD male rats were selected and randomly grouped as follows： sham， MCAO， deferoxamine mesylate， high-dose HSHS （HSHS-H， 0.54 g·kg^-1）， and low-dose HSHS （HSHS-L， 0.27 g·kg^-1）， with 6 rats in each group. A laser scattering system was used to evaluate the stability of the MCAO model， and rats were administrated with corresponding agents by gavage for 7 days. During the administration period， behavioral， imaging and other methods were used to systematically evaluate the skeletal muscle tissue injury after MCAO and the therapeutic effect in each administration group. Hematoxylin-eosin staining was employed to evaluate the cross-section of muscle cells. Subsequently， immunohistochemistry was used to detect tumor suppressor p53 and glutathione peroxidase 4 （GPX4） in the soleus tissue. Western blot was employed to determine the protein levels of p53， GPX4， myogenic differentiation 1 （MyoD1）， nuclear factor E₂-related factor 2 （Nrf2）， Myostatin， solute carrier family 7 member 11 （SLC7A11）， muscle ring-finger protein-1 （MuRF1）， and muscle atrophy F-box protein （MAFbx） to verify the therapeutic effect in each group. ResultsCompared with the MCAO group， HSHS enhanced the locomotor ability and promoted muscle regeneration， which suggested that the pharmacological effects of HSHS were related to the inhibition of muscle tissue ferroptosis to reduce the expression of muscle atrophy factors. Behavioral and imaging results suggested that compared with the MCAO group， HSHS ameliorated neurological impairments in rats on day 7 （P<0.01）， enhanced 5-min locomotor distance and postural control （P<0.01）， strengthened grasping power and promoted muscle growth （P<0.01）， stabilized skeletal muscle length and weight （P<0.01）， and increased the cross-section of muscle cells （P<0.01）. Compared with the MCAO group， HSHS promoted the increases in glutathione and superoxide dismutase content and inhibited the increase in malondialdehyde content （P<0.05，P<0.01）. Ferroptosis pathway-related assays suggested that HSHS reduced the p53-positive cells and increased the GPX4-positive cells （P<0.01）. HSHS ameliorated muscle function decline after stroke by promoting the expression of GPX4， Nrf2， SLC7A11， and MyoD1 and inhibiting the expression of p53， Myostatin， MurRF1， and MAFbx to reduce ferroptosis in the muscle （P<0.01）. ConclusionHSHS， prepared with reference to the method in the Synopsis of Golden Chamber， can simultaneously reduce the myolysis and increase the protein synthesis in the skeletal muscle tissue after ischemic stroke by regulating the ferroptosis pathway.

Objective To observe the therapeutic effects and mechanisms of Guanyuan Mingmen Sequential Acupuncture on rats with premature ovarian insufficiency(POI)model.Methods Female SD rats were divided into the blank group,the model group,the protein kinase A(PKA)inhibitor(H89)+acupuncture group,and the acupuncture group,with 12 rats in each group.Except for the blank group,the POI model was prepared by gavage with Tripterygium Glycosides Tablets in the other three groups of rats.After the model was successfully established,the blank group and the model group were bundled once a day;in the acupuncture group,Guanyuan(RN4)point was taken during the intermotility period,and in the pre-motility period,Mingmen(DU4)point was taken;in the H89+acupuncture group,the intervention was performed in accordance with the acupuncture protocol of the acupuncture group,and H89 was injected intraperitoneally for 30 minutes prior to each acupuncture session.Continuous intervention was performed for 20 days.Samples were taken from each group of rats in the first estrus period and in proestrus period after intervention.Enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of follicle stimulating hormone(FSH)and estradiol(E2)during the estrous phase,Western Blot was used to measure the protein expressions of follicle stimulating hormone receptor(FSHR)and aromatase P450(P450arom)during the estrous phase,and the activity of granulocytes during the estrous phase and the proestrus phase were measured using the cell-counting kit 8(CCK-8)method.The immunohistochemistry method was used to detect the protein expression of pre-motility proliferating cell nuclear antigen(PCNA).Results(1)Compared with the blank group,the serum FSH level of the model group and H89+acupuncture group was significantly increased(P＜0.01),and the E2 level was significantly decreased(P＜0.001);there was no difference between the FSH level of the H89+acupuncture group and that of the model group(P＞0.05),and the E2 level of the H89+acupuncture group was lower than that of the model group(P＜0.05);the FSH level of the acupuncture group was lower than that of the model group and that of the H89+acupuncture group(P＜0.05),had no difference with the blank group(P＞0.05),E2 level was significantly higher than the model group and H89+ acupuncture group(P＜0.01),still being lower than the blank group(P＜0.05).(2)The protein expressions of FSHR and P450arom in the model group and H89 + acupuncture group was lower than those in the blank group;the protein expression of FSHR in the H89 + acupuncture group was not different from that in the model group(P＞0.05),while the protein expression level of P450arom was lower than that in the model group(P＜0.05);the protein expression levels of FSHR and P450arom in the acupuncture group were higher than those in the model group and H89 + acupuncture group,but still lower than those in the blank group(P＜0.05).(3)Both GCs activity and average optical density value of PCNA in the model group and H89+acupuncture group were lower than the blank group(P＜0.05);both GCs activity and average optical density value of PCNA in the H89+acupuncture group were lower than the model group(P＜0.05);the activity of GCs and average optical density value of PCNA of the acupuncture group were significantly higher than that of the model group and H89+acupuncture group(P＜0.05 or P＜0.01).Conclusion Guanyuan Mingmen Sequential Acupuncture can regulate sex hormone levels,increase GCs activity and promote GCs cell proliferation by up-regulating protein expressions of follicle stimulating hormone receptor(FSHR)/cyclic adenosine monophosphate(cAMP)/protein kinase A(PKA)pathway FSHR,P450arom,thus improving POI.

Objective To explore the difference in efficacy of metoprolol versus ivabradine in the treatment of postural orthostatic tachycardia syndrome(POTS)in the elderly after COVID-19 infection.Methods A total of 110 patients diagnosed with POTS at our department from Decem-ber 1,2022 to January 31,2023 were included.According to their drug regimen,they were divided into metoprolol group(62 patients)and ivabradine group(48 patients).On the 28th day of out-patient follow-up,the resting heart rate,heart rate of 10 min of standing,symptom disappearance rate,hospitalization rate,and mortality rate were compared between the two groups.Results On the 28th day of treatment,the resting heart rate and postural heart rate for 10 min were decreased in both groups when compared with the levels at initial diagnosis(P＜0.01).And there were no significant differences in the two types of heart rate between the two groups on the 28th day(71.0±7.0 vs 72.1±7.0,P=0.401;76.5±7.2 vs 77.4±7.6,P=0.573).No obvious differences were observed between the two groups in symptom disappearance rate,hospitalization rate,or mortality rate(88.7％vs 89.6％,3.2％vs2.1％,0％vs 0％,P＞0.05).Conclusion Metoprolol and ivabradine can effectively treat POTS in the elderly patients after COVID-19 infection.

Objective:To construct a predictive model for the risk of major adverse cardiovascular events(MACE) after surgery in patients with symptomatic arteriosclerosis obliterans(ASO) .Methods:From Jan 2018 to Dec 2021, 957 patients with symptomatic ASO admitted to Nanjing Drum Tower Hospital were selected and divided into MACE and non-MACE groups according to whether they had a post-op MACE. A risk prediction model was constructed based on a stepwise regression method with multi-factor COX regression analysis. The model was evaluated using the receiver operating characteristic curve (ROC), the calibration curve to assess the model fit, and the Bootstrap method for internal validation.Results:MACE occurred in 143 patients (14.94%). After COX regression analysis, BMI, creatinine clearance, fibrinogen, rivaroxaban and previous history of surgery were enrolled into model constructing. The ROC curve assessed the model with a C-statistic of 0.690 (95% CI: 0.644-0.736), sensitivity and specificity of 49.2% and 80.7% respectively, a Jorden index of 0.299 and an optimal cut-off value of 0.086. Calibration curves showing agreement between predicted and actual observed values. Internally validated C-statistic of 0.689 (95% CI: 0.672-0.700). The population was divided into high and low risk groups based on the best cut-off value and analysed for survival. The difference between the two groups was statistically different. Conclusion:The risk prediction model for the occurrence of MACE based on clinical parameters is simple and convenient, with good predictability and good discriminatory ability, and can provide reference for the assessment and treatment of MACE in ASO patients.

Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.