AIM: To analyze the influencing factors of capsular constriction syndrome(CCS)in cataract patients after phacoemulsification(Phaco)combined with intraocular lens(IOL)implantation.METHODS: Retrospective study. The data of 2 900 cataract patients(2 900 eyes)in our hospital's information system from January 2021 to January 2024 were collected. All patients were treated with Phaco combined with IOL implantation, and the incidence of CCS within 30 wk after surgery was recorded. Patients were categorized into CCS(116 cases, 116 eyes)and N-CCS group(2 784 cases, 2 784 eyes)based on the occurrence of CCS. The basic data of the two groups were compared, and the influencing factors of CCS within 30 wk after Phaco combined with IOL implantation in cataract patients were analyzed by multivariate Logistic regression.RESULTS: Among 2 900 patients(2 900 eyes)included, 116 cataract patients(116 eyes)developed CCS within 30 wk after Phaco combined with IOL implantation, with an incidence rate of 4.00%. The single factor and multi-factor Logistic regression analysis showed that the complicated diabetes, high myopia, complicated glaucoma, and axial length(AL)>30 mm were the risk factors for the occurrence of CCS after Phaco IOL implantation in cataract patients(all P<0.05).CONCLUSION: Attention should be paid to cataract patients with diabetes, high myopia, glaucoma and AL>30 mm, which will increase the risk of CCS within 30 wk after Phaco combined with IOL implantation in cataract patients.

Objective:To investigate the changing trends in cardiac function following xenogeneic heterotopic heart transplantation of multi-gene edited pig hearts and assess the impact of recipient immune responses on donor heart, laying experimental groundwork for the clinical application of gene editing technology.Methods:On December 16, 2023, xenogeneic heterotopic heart transplantation was performed between pigs and rhesus monkeys. Functional status of the graft under post-transplantation load conditions and recipient immune indicators were observed.Results:The recipient monkeys survived for 40 days with satisfactory functionality of both donor and recipient hearts, and no hyperacute or acute immune rejection reactions were observed.Conclusion:Multi-gene editing technology provides potential for xenotransplantation, yet further exploration is needed for its clinical application.

Objective:To investigate the clinical and genetic characteristics of cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) with replication factor C subunit 1 (RFC1) gene mutation to improve the understanding of this disease.Methods:A case of CANVAS diagnosed in the Peking University Third Hospital in January 2021 was reported. Detailed genetic analyses of ataxia were performed with DNA extracted from the peripheral blood of the patient. Studies including pathogenic variants of RFC1 gene causing CANVAS were reviewed and the clinical and genetic characteristics of the disease were summarized.Results:The patient was a 51-year-old female with the prominent manifestation of progressive walking instability. And the clinical data met the diagnostic criteria of CANVAS. The genetic tests excluded other hereditary ataxia mutations and identified the biallelic expansion of the pathogenic variant structure (AAGGG)exp repeat amplification in RFC1 gene. A total of 14 studies on CANVAS with RFC1 gene mutation were reviewed. The overall mutation rate of RFC1 gene in CANVAS was 68%-100%, and it varied in sporadic and familial CANVAS. And the mutation had ethnic differences.Conclusions:Among adult patients with late-onset ataxia, the combination of brain magnetic resonance imaging, electrophysiology tests and vestibular function examination is beneficial to the identification of CANVAS. And the genetic test of RFC1 gene has significant value in the diagnosis of this disease. This patient with CANVAS expands the disease spectrum of ataxia in China, and confirms that RFC1 gene mutation is of great significance in the screening of ataxia disorders in the Chinese population.

Objective:To evaluate the development and application of gastrointestinal endoscopy technology in Beijing-Tianjin-Hebei (BTH) region from 2016 to 2020, and the impact of the corona virus disease 2019 (COVID-19) epidemic on gastrointestinal endoscopy screening and lesion detection rate of medical institutions.Methods:Data of gastroscopy and colonoscopy cases from 26 cooperative institutions in BTH Region Gastrointestinal Endoscopy Medical Association from January 2016 to December 2020 were collected by questionnaire. The number of gastrointestinal endoscopy, the detection of main lesions (including upper gastrointestinal malignant tumors, early gastric cancer and colon cancer), and the number of endoscopic treatment were retrospectively analyzed by year.Results:From 2016 to 2019, the number of gastroscopy and colonoscopy showed a yearly increasing trend with an annual growth rate of over 10%. Compared with 2019, the number of gastroscopy and colonoscopy decreased by 10.86% and 8.29%, respectively, in 2020 due to the impact of the epidemic. The annual detection rates of upper gastrointestinal malignant tumors, early gastric cancer and colon cancer were on a rise, from 7.22%, 1.49% and 8.98% in 2016 to 9.87%, 2.71% and 12.04% in 2020, respectively. The number of gastroscopic mucosal resection, submucosal dissection and colonoscopic endoscopic submucosal dissection increased yearly, from 2 132, 300 and 217 cases in 2016 to 5 466, 872 and 560 cases in 2020, respectively.Conclusion:The Medical Association has promoted the expansion of endoscopic screening and the application of endoscopic treatment techniques, resulting in a continuous increase in the endoscopy detection rate and early cancer diagnosis rate in the BTH region. The sharp decrease of gastrointestinal endoscopy procedures and the increase in the lesion detection rate in 2020 reflect the impact of epidemic COVID-19 on detection of gastrointestinal cancers.

Objective:To compare reconstruction of acromioclavicular ligament versus internal fixation of acromioclavicular joint with clavicle hook plate in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular dislocation by reconstruction of coracoclavicular ligament with suture anchor.Methods:A retrospective analysis was conducted of the 56 patients who had been treated for Rockwood Ⅲ-Ⅴ acromioclavicular dislocation from January 2015 to June 2019 at Department of Orthopaedic Trauma, Qilu Hospital of Shandong University (Qingdao). Of them, 26 were treated by reconstruction of coracoclavicular ligament with suture anchor plus reconstruction of acromioclavicular ligament (reconstruction group) and 30 by reconstruction of coracoclavicular ligament with suture anchor plus internal fixation of acromioclavicular joint with clavicle hook plate (plate group). The 2 groups were compared in terms of operation time, intraoperative blood loss, Constant-Murley score and Subjective Shoulder Rating System (SSRS) score at the last follow-up, and complications.Results:The 2 groups were comparable because there were no significant differences between them in the baseline data before operation ( P>0.05). The reconstruction group was followed up for 6 to 15 months (average, 7.9 months) while the plate group for 7 to 18 months (average, 11.3 months). The average operation time was (79.9±12.6) min for the reconstruction group and (69.1±8.5) min for the plate group, showing a significant difference ( P<0.05). No significant difference was found between the 2 groups in the intraoperative blood loss [(68.5±19.1) mL versus (65.0±16.6) mL] ( P>0.05). The differences were statistically significant between the 2 groups in Constant-Murley score (87.9±3.4 for the reconstruction group versus 91.9±3.5 for the plate group) and in SSRS score (85.1±4.1 for the reconstruction group versus 88.6±3.0 for the plate group) ( P<0.05). All the wounds healed well in the reconstruction group except for one patient who reported numbness around the wound which disappeared spontaneously 3 months postoperation. In the plate group, incision infection occurred in 2 cases, the redness and swelling in one which responded to dressing change 3 weeks later and numbness around the incision in one which was recovered 5 months after operation. Conclusions:Both surgical procedures can achieve good to excellent clinical outcomes. Although reconstruction of both acromioclavicular and coracoclavicular ligaments takes more operation time, it may lead to better Constant-Murley and SSRS scores and fewer complications, and spare secondary operation.

Objective To investigate the effects from head angle and locking times of locking screws on mechanical properties of the screw-plate system, so as to provide a theoretical basis for doctors to select appropriate locking screws and master the locking times in clinical surgical procedure. Methods Locking screws with different head angles were selected to match with locking compression plates in the case of different locking times, and cantilever bending method was used to compare the differences of mechanical properties in each group. Results There were significant differences in failure load and bending stiffness between locking compression plate and locking screw with different head angles (P<0-05). The mechanical properties of the screw-plate system with the best locking degree were optimum. There was no significant difference between 3 time-locking and 1 time-locking (P>0-05). The failure modes of locking screw with different head angles and different locking times were different, and the failure mode of locking screw had a positive correlation with its head angle and locking times. Conclusions The differences in mechanical properties between locking screw with different head angles and locking compression plate cannot be neglected. It is suggested that doctors should choose locking screw and locking compression plate with the best locking degree in clinical procedure, and choose the right torque wrench to lock in multiple times if necessary, thus to prevent screw loosening from affecting recovery of the patients.

Objective: To identify the independent risk factors of esophageal varices (EV) in cirrhosis by endoscopic ultrasonography (EUS), and further to establish a risk assessment model for predicting EV occurrence and evaluate the clinical predictive value of the model. Methods: A retrospective cohort study was used in this study. Data of patients with cirrhosis without varicosity, who were hospitalized in Tianjin Second People's Hospital from September 2014 to March 2017 were collected. The location, diameter, and number of esophageal collateral circulation were measured by EUS. The non-selective beta blocker (NSBB) medication history and antiviral therapy were recorded. The time of the first EUS examination was taken as the starting point and the follow-up period was set up as 18 months. The end point was the occurrence of EV or the end of follow-up. The independent risk factors of EV occurrence were determined by univariate and multivariate logistic regression analysis, and the risk assessment model of EV occurrence was constructed. The predictive value of evaluation model for disease was studied by ROC analysis. Hosmer-Lemeshow goodness of fit was used to test the fitting efficiency of the evaluation model. Results: A total of 638 subjects were recruited initially, 13 of them were lost in the course of the study. Finally, 625 cases were included in the study. Among them, 369 cases did not develop EV (the non-progress group) and 256 cases developed EV (the progress group). (1) Multivariate logistic regression analysis showed that 7 independent risk factors were selected into the risk assessment model of EV occurrence, and were assigned corresponding scores: no NSBB (3 points), no antiviral treatment (2 points), Child-Pugh stage B (1 point), the diameter of peri-ECV>2 mm (1 point), the number of peri-ECV≥5 (3 points), the diameter of para-ECV≥5 mm (4 points), and the number of para-ECV≥5 (4 points). (2) In the risk assessment model, the risk factor scores ranged from 1 to 4 with a total score of 0-18. The predicted incidence of EV increased from 0.003 to 1.000 with the increase of the score. (3) In the risk assessment model, the total risk score ≤2 was assigned into low-risk group, 3-5 into medium-risk group, and ≥6 into high-risk group. The actual EV incidence of each risk stratification was 2.78% in the low-risk group, 36.36% in the medium-risk group and 93.91% in the high-risk group, respectively. (4) The ROC analysis showed that area under curve (AUC) was 0.947 (P<0.05), suggesting that the risk assessment model had a good effect on predicting disease progression. Hosmer-Lemeshow test showed that P was 0.450, suggesting that the model fitted well. Conclusion The risk assessment model based on EUS can accurately predict the occurrence of EV, and is simple and easy to use. The model can provide scientific basis for the prevention and rational treatment of EV in liver cirrhosis.

Objective To assess the clinical value of endoscopic ultrasonography ( EUS ) for predicting esophageal varices ( EV ) progression in patients with hepatitis B virus ( HBV )-related hepatocirrhosis. Methods A retrospective cohort study was performed on 299 HBV-related hepatocirrhosis patients with light EV in Tianjin Second People′s Hospital admitted from September 2014 to September 2015. The diameter and number of peri-esophageal collateral veins ( ECV ) and para-ECV were measured and described by EUS. The first EUS examination time was the starting point, and the follow-up of 24 months or EV progression was the end. Risk factors of EV progression were evaluated by multivariate Cox regression model, and the predictive value of EUS for EV progression was analyzed by receiver operating characteristic ( ROC) curve. Results The cumulative incidence of EV progression was 2. 3％ ( 7/299 ) , 14. 8％( 44/297) , 33. 7％ ( 96/285) and 40. 0％ ( 120/273) at 6 months, 12 months, 18 months and 24 months of follow-up, respectively. The results of multivariate Cox regression analysis showed that the diameter of peri-ECV ( P=0. 0112, HR=1. 3232, 95％CI: 1. 0656-1. 6429 ) , the number of peri-ECV ( P=0. 0001, HR=1. 3666, 95％CI:1. 1634-1. 6052) and para-ECV diameter ( P=0. 0002, HR=1. 3641, 95％CI:1. 1558-1. 6100) were risk factors for EV progression. The use of nucleoside analogues treating HBV (P=0. 0020, HR=0. 4969, 95％CI: 0. 3186-0. 7751) and non-selective β-blockers descending portal venous pressure ( P=0. 0765, HR=0. 5732, 95％CI:0. 3097-1. 0611) were the protective factors for EV progression. The results of ROC curve analysis showed that the diameter of peri-ECV[ P<0. 001, area under the curve (AUC)= 0. 850, 95％CI: 0. 804-0. 895], the number of peri-ECV (P<0. 001, AUC=0. 831, 95％CI: 0. 784-0. 878), the diameter of para-ECV (P<0. 001, AUC=0. 924, 95％CI: 0. 895-0. 954) , and the number of para-ECV ( P<0. 001, AUC=0. 761, 95％CI: 0. 704-0. 817 ) had higher predictive value for EV progression;and the optimum cut-off values of each index were 1. 85 mm, 3. 5, 3. 35 mm, and 4. 5, respectively. The accuracies of prediction for EV progression were 76. 60％, 75. 19％, 84. 48％ and 70. 29％, respectively. Conclusion EUS can be used to predict EV progression in HBV-related hepatocirrhosis patients. Peri-ECV diameter>1. 85 mm, number>3. 5, and para-ECV diameter>3. 35 mm, number>4. 5 suggest a high risk of EV progression. For patients with HBV-related hepatocirrhosis complicated with mild EV, nucleoside analogues to anti-HBV and non-selective β-blockers to reduce portal hypertension can prevent EV progression.

OBJECTIVE： To investigate the correlation of ADPRT rs1136410 polymorphism with the occurrence of non-small cell lung cancer （NSCLC） in Han nationality from northern Jiangsu. METHODS： A total of 283 patients with primary NSCLC of Han nationality in Northern Jiangsu were selected from the Affiliated Hospital of Xuzhou Medical University during Nov. 2015-Dec. 2018 as NSCLC group. A total of 210 healthy subjects underwent physical examination were included in control group. PCR-RFLP was utilized to determine the genotypes at ADPRT rs1136410 locus. Logistic regression model was used to evaluate the effect of polymorphism and its interaction with smoking on the occurrence of NSCLC. RESULTS： There was no statistical significance in age and gender between 2 groups （P＞0.05）. The proportion of smoker in NSCLC group was significantly higher than control group （P＜0.05）. TT， TC and CC genotypes were detected at rs1136410 locus of ADPRT gene. The frequency of TT， TC and CC genotype were 41.9％，44.8％ and 13.3％， and those of allele T and C were 64.3％ and 35.7％ in control group. The frequency of TT， TC and CC genotype were 21.6％， 50.2％ and 28.2％， and those of allele T and C were 46.6％ and 53.4％ in NSCLC group， respectively. The frequencies of genotypes in 2 groups were in accordance with Hardy-Weinberg equilibrium （P＞0.05）， while there was significant difference in genotype and allele frequencies between 2 groups （P＜0.05）. Compared with TT genotype， the risk of NSCLC in individuals carrying TC and CC genotypes raised by 1.179， 3.122 folds [ORTC＝2.179， 95％CI （1.435， 3.309）， P＜0.05； ORCC＝4.122，95％CI（2.401，7.075），P＜0.05]. Compared with individuals carrying TT genotype， the risk of NSCLC occurrence in non-smokers carrying TC and CC genotypes increased by 0.371， 1.328 fold [ORTC＝1.371，95％CI （0.927，3.428），P＜0.05； ORCC＝2.328，95％CI （1.249，4.622），P＜0.05]； and the risk of NSCLC occurrence in smokers carrying TC and CC genotypes increased by 0.928， 2.182 folds [ORTC＝1.928，95％CI （1.257，2.957）， P＜0.05；ORCC＝3.182，95％CI （1.760，5.754）， P＜0.05]. CONCLUSIONS： The rs1136410 locus mutant genotype of ADPRT gene is the risk factor of NSCLC in Han nationality from Northern Jiangsu， and smoking raises this risk of NSCLC occurrence in individuals with mutation genotypes of ADPRT rs1136410.

Objective: To study clinical characteristics and treatment after colonscopic perforation, and to determine risk factors for postoperative complications. Methods: Cases diagnosed as colonoscopic perforation within 7 days after colonoscopy in Peking Union Medical College Hospital between January 2010 and January 2017 were reviewed. Data regarding demography (age, sex), clinical information (comorbidities, medication history of glucocorticoid, length of hospital stay), colonoscopy (whether endoscopic therapy or anesthesia was performed, intestinal cleanliness), perforation (region, diagnosing time) and operation (laparotomy or laparoscopic operation, procedure, post-operational complications) were collected. Single factor analysis and Spearman correlation analysis were employed to determine the risk factors of postoperative complications. Results: A total of 14 colonoscopic perforation cases were identified and included in this study, and the overall perforation rate was 0.03%. Most perforations occurred in rectum (2 cases) and sigmoid colon (8 cases). Twelve perforation patients received operational treatment, of who 6 developed postoperative complications, including 3 cases of incision infection, 2 cases of peritoneal infection, 1 case of catheter-related infection and 1 case of pulmonary embolism. Spearman correlation analysis showed that preoperative medication of glucocorticoid and non-rectosigmoid perforation were positively related to postoperative complications (both correlation coefficients were 0.707, P=0.01), while perforation diagnosed immediately and satisfying intestinal cleanliness were negatively related to it (both correlation coefficients were -0.667, P<0.05). Conclusion Perforations are rare but severe complications of colonoscopy, and surgical interventions are necessary in most cases. Postoperative complications were significantly related to perforation sites, preoperative medication of glucocorticoid, perforation diagnosis time and intestinal cleanliness.