AIM: To investigate the effect of the relationship between scotopic pupil and optical zone diameters on short-term subjective and objective visual quality after small incision lenticule extraction(SMILE).METHODS:In this prospective cohort study, 98 patients(196 eyes)who underwent SMILE from September 2021 to June 2023 were included. Participants were divided into two groups based on the ratio of scotopic pupil diameter to optical zone diameter: group A(ratio >1, 70 eyes)and group B(ratio ≤1, 126 eyes). The preoperative and postoperative uncorrected visual acuity(UCVA), spherical equivalent(SE), total corneal high-order aberrations at 4, 6, and 8 mm of pupil diameters, objective scatter index(OSI), pre- and post-operative QoV subjective visual quality questionnaire were observed and recorded. The refractive status of different groups of patients at different time points before and after surgery, and differences in subjective and objective visual quality indices were analyzed. Furthermore, the changes in subjective and objective visual quality(postoperative-preoperative)at different postoperative time points were analyzed between the two groups.RESULTS:No significant differences in visual acuity or refractive state were observed between the two groups at 3 mo postoperatively. In both the group A and the group B, there was a difference in the changes of corneal total higher-order aberration centered on 8 mm cornea at 1 mo postoperatively(P<0.05), and there was a difference in the changes of total higher-order aberration and corneal spherical aberration centered on 8 mm cornea at 3 mo postoperatively(all P<0.05). At 3 mo after surgery, the most commonly reported symptoms in the group A were glare, starburst, hazy vision, and halo. In the group B, the most common symptoms were hazy vision, halo, starburst, and glare. Statistically significant differences were observed in the severity of glare and visual fluctuation between groups before surgery and at 3 mo postoperatively(all P<0.05). However, no significant differences were found in the severity of halo, starburst, blurred vision, double vision, or focusing difficulty at 3 mo postoperatively(all P>0.05).CONCLUSION:When the scotopic pupil diameter exceeds the optical zone, SMILE may increase postoperative corneal aberrations, as evidenced by an increase in high-order corneal aberrations within an 8-mm central corneal range, a higher incidence of postoperative glare, and more severe glare and visual fluctuation symptoms. Nevertheless, these symptoms are mild and remain within a safe range.

AIM: To explore the relationship between hyperopia reserve and ocular biometric parameters in 4-14 year-old Uyghur students from Hotan County, Xinjiang, and to provide scientific evidence for myopia prevention.METHODS: From September 1 to October 31, 2023, a stratified random cluster sampling method was used to select 3 264 students(3 264 eyes)from 6 schools in Hotan County. Participants underwent uncorrected distance visual acuity testing, cycloplegic refraction, and ocular biometric measurements. The correlation between spherical equivalent(SE)and ocular biometric parameters was analyzed by multiple linear regression.RESULTS: A total of 1 998 non-myopic students(1 998 eyes)were included in the study, with 1 354 students(67.77%)showing insufficient hyperopia reserve. The detection rate of insufficient hyperopia reserve decreased with age, from 94.12% at age 4 to 18.13% at age 14(P<0.001). Multiple linear regression analysis showed that in the group with sufficient hyperopia reserve, age, gender, uncorrected distance visual acuity, axial length(AL), and keratometry(K)explained 66.5% of the variance in SE; while in the group with insufficient hyperopia reserve, these factors explained only 28.0% of the SE variance.CONCLUSION: In non-myopic Uyghur students aged 4-14 in Hotan County, Xinjiang, the detection rate of insufficient hyperopia reserve was 67.77%. In the group with insufficient hyperopia reserve, age, gender, AL, and K explained only a small portion of the SE variance, suggesting that the refractive status of this population may be influenced by more complex factors.

Objective: To explore methods about how to treat penile foreign body incarceration，so as to provide reference for clinical treatment of such cases. Methods: The diagnosis and treatment of a patient with penile metal foreign body incarceration from the Department of Pediatric Surgery of Tongji Hospital was analyzed，relevant Chinese and English literature were retrieved，and treatment methods and outcomes were summarized. Results: A 11-year-old boy came to our hospital with a screw nut incarcerated around the penis for over 10 days，the distal penis dark red swelling，local epidermis exfoliation oozing.A wire saw was used to cut and remove the incarcerated object.The patient recovered well，with no secondary damage to the penis，and no dysfunctions like dysuria.The search of the Chinese and English databases obtained a total of 79 penile incarceration-related papers involving 184 cases.Treatment methods included direct removal after bloodletting for detumescence，removal after cutting with various instruments，and penis skin degloving. Conclusion: Since penile incarceration is a rare emergency，early treatment can avoid complications with good prognosis.Methods dealing with penile foreign body incarceration have both pros and cons.Therefore，selection of the appropriate methods needs comprehensive evaluation，or follows the order of simple-to-complex operations.

Psoriasis is a chronic inflammatory skin disease with a polygenic genetic background. Its etiology remains unclear， and its pathogenesis is complex and refractory， collectively posing significant challenges in its treatment and greatly affecting the physical and mental health of patients. With the advantages of multi-target and multi-pathway treatment， traditional Chinese medicine has shown unique efficacy and value in the diagnosis and treatment of psoriasis. Modern doctors have a lot of discussion on psoriasis， and most of them tend to treat the disease by solving disorders of the blood system. They think that the disease is closely related to the "heat in the blood". Combining the clinical characteristics and accompanying symptoms of psoriasis， this article traced the causes of "heat in the blood" in psoriasis and believed that multiple internal and external factors have prevented the smooth circulation of Qi. Yang Qi Fuyu （stagnation） and transformation into heat and toxicity is the source of "heat in the blood" in psoriasis. Furthermore， it was proposed that "Fuyu" is the core pathogenesis of psoriasis. The etiology of "Fuyu" is complex， such as external wind and cold pathogens， emotional injuries， internal accumulation of dampness， and deficiency of healthy Qi， all of which can disrupt the ascending and descending movement of Qi， impede the circulation of Qi and fluids， close the pores and skin texture， and subsequently lead to stagnation. Based on the above understanding， "resolving stagnation" is crucial for treating the disease. Many doctors have explored the treatment ideas of psoriasis from the perspectives of dispelling wind， warming cold， regulating Qi， eliminating dampness， tonifying deficiency， and external treatment， aiming to remove the causes， promote the circulation of Qi and fluids， and resolve stagnation and heat. Clinical studies have shown that the therapies can relieve clinical symptoms， reduce recurrence rate， and improve quality of life， which also have good safety in the treatment of psoriasis. This article discussed the treatment of psoriasis from the perspective of "Fuyu"， enriching the understanding of TCM regarding the etiology and pathogenesis of psoriasis. It is aiming to serve as an effective supplement to the "treating by solving disorders of the blood system" approach and provide a reference for clinical diagnosis and treatment of psoriasis.

Psoriasis is a chronic inflammatory skin disease with a polygenic genetic background. Its etiology remains unclear， and its pathogenesis is complex and refractory， collectively posing significant challenges in its treatment and greatly affecting the physical and mental health of patients. With the advantages of multi-target and multi-pathway treatment， traditional Chinese medicine has shown unique efficacy and value in the diagnosis and treatment of psoriasis. Modern doctors have a lot of discussion on psoriasis， and most of them tend to treat the disease by solving disorders of the blood system. They think that the disease is closely related to the "heat in the blood". Combining the clinical characteristics and accompanying symptoms of psoriasis， this article traced the causes of "heat in the blood" in psoriasis and believed that multiple internal and external factors have prevented the smooth circulation of Qi. Yang Qi Fuyu （stagnation） and transformation into heat and toxicity is the source of "heat in the blood" in psoriasis. Furthermore， it was proposed that "Fuyu" is the core pathogenesis of psoriasis. The etiology of "Fuyu" is complex， such as external wind and cold pathogens， emotional injuries， internal accumulation of dampness， and deficiency of healthy Qi， all of which can disrupt the ascending and descending movement of Qi， impede the circulation of Qi and fluids， close the pores and skin texture， and subsequently lead to stagnation. Based on the above understanding， "resolving stagnation" is crucial for treating the disease. Many doctors have explored the treatment ideas of psoriasis from the perspectives of dispelling wind， warming cold， regulating Qi， eliminating dampness， tonifying deficiency， and external treatment， aiming to remove the causes， promote the circulation of Qi and fluids， and resolve stagnation and heat. Clinical studies have shown that the therapies can relieve clinical symptoms， reduce recurrence rate， and improve quality of life， which also have good safety in the treatment of psoriasis. This article discussed the treatment of psoriasis from the perspective of "Fuyu"， enriching the understanding of TCM regarding the etiology and pathogenesis of psoriasis. It is aiming to serve as an effective supplement to the "treating by solving disorders of the blood system" approach and provide a reference for clinical diagnosis and treatment of psoriasis.

OBJECTIVE To evaluate the cost-effectiveness of capecitabine metronomic chemotherapy combined with aromatase inhibitor （AI） versus AI monotherapy as first-line treatment for hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） metastatic breast cancer， thereby providing evidence-based support for clinical therapeutic decision- making and healthcare policy formulation. METHODS Based on the MECCA trial， a partitioned survival model was constructed using a 4-week cycle length to simulate outcomes over patients’ lifetime. The model outputs included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analyses were performed to validate the robustness of base-case results， while scenario analyses examined the cost-effectiveness of both treatment strategies under 10-year， 20-year， and lifetime time horizons. RESULTS With the willingness-to-pay （WTP） threshold set at 1 times China’s 2024 per capita gross domestic product （GDP） （95 749 yuan/QALY）， patients receiving capecitabine metronomic chemotherapy combined with AI regimen gained incremental utility （0.66 QALYs） while incurring higher costs， with ICER of 27 684.85 yuan/QALY. Results of the one-way sensitivity analysis showed that factors with significant impacts on ICER included the cost discount rate， drug costs of the capecitabine metronomic chemotherapy combined with AI group， utility value in the progression-free survival state， follow-up costs， and treatment costs in the subsequent stablephase. Probabilistic sensitivity analysis indicated that when the WTP threshold ≥49 250 yuan/QALY， the capecitabine metronomic chemotherapy combined with AI regimen had a 100% probability of being cost-effective. Scenario analysis results demonstrated that capecitabine metronomic chemotherapy combined with AI regimen was more cost-effective than the AI alone regimen across 10-year， 20-year， and lifetime study horizons. CONCLUSIONS Under the premise that the WTP threshold is set at 1 times China’s per capita GDP in 2024， capecitabine metronomic chemotherapy combined with AI regimen is more cost-effective than the AI alone regimen as the first-line treatment for HR+/HER2－ metastatic breast cancer.

ObjectiveTo investigate the mechanism by which Mingshi prescription regulates the retinal melanopsin-dopamine （Opn4-DA） axis in myopic mice to inhibit endoplasmic reticulum （ER） stress in the retina and sclera， thereby delaying axial elongation associated with myopia. MethodsSixty 4-week-old male SPF-grade C57BL/6J mice were randomly divided into a normal group， a form-deprived myopia group （FDM group）， an intrinsically photosensitive retinal ganglion cells ablation group （ipRGCs group）， a Mingshi Prescription group （MSF group， 5.2 g·kg^-1）， and an ipRGCs + MSF group （5.2 g·kg^-1）. Except for the normal group， all other groups underwent FDM modeling. Additionally， the ipRGCs and ipRGCs + MSF groups received retinal ipRGC ablation. Three weeks after modeling， the MSF and ipRGCs + MSF groups were administered Mingshi prescription via continuous gavage for six weeks. After refraction and axial length were measured in all mice， eyeballs were collected along with retinal and scleral tissues. Pathological and morphological changes in the retina， choroid， and sclera were observed using periodic acid-Schiff （PAS） staining. Western blot was employed to detect the relative protein expression levels of dopamine D1 receptor （DRD1）， C/EBP homologous protein （CHOP）， and glucose-regulated protein 78 （GRP78） in the retina， and CHOP and GRP78 in the sclera. Real-time PCR was used to detect the relative mRNA expression of Opn4， CHOP， and GRP78 in the retina， and CHOP and GRP78 in the sclera. Immunofluorescence staining （IF） was performed to detect the expression of Opn4 and DRD1 in retinal tissues. ResultsCompared with the normal group， the FDM group showed a significant myopic shift in refraction （P<0.05） and a significant increase in axial length （P<0.05）. The retinal layers were thinner， the number of ganglion cells was reduced， and collagen fibers in the sclera were loosely arranged with evident gaps. Opn4 and DRD1 protein and mRNA expression in the retina were significantly decreased （P<0.05）， while CHOP and GRP78 protein and mRNA expression in both retinal and scleral tissues were significantly increased （P<0.05）. Compared with the FDM group， the ipRGCs group exhibited further increases in myopic refraction and axial length （P<0.05）， more pronounced thinning and looseness in the retinal， choroidal， and scleral layers， lower expression of Opn4 and DRD1 protein and mRNA in the retina （P<0.05）， and higher expression of CHOP and GRP78 protein and mRNA in the retina and sclera （P<0.05）. Compared with the FDM group， the MSF group showed significantly reduced refractive error and axial length （P<0.05）， with improved cellular number， arrangement， and thickness in ocular tissues， increased Opn4 and DRD1 protein and mRNA expression in the retina （P<0.05）， and reduced CHOP and GRP78 protein and mRNA expression in both retina and sclera （P<0.05）. Similarly， the ipRGCs + MSF group showed significant improvements in terms of the above items compared with the ipRGCs group （P<0.05）. ConclusionMingshi Prescription delays myopic axial elongation and refractive progression by regulating the Opn4-DA axis in the retina of myopic mice， thereby inhibiting ER stress in the retina and sclera. This intervention promotes Qi and blood nourishment of the eyes， softens the fascia， and restores ocular rhythm.

OBJECTIVE To evaluate the efficacy and safety of apatinib combined with PD-1/PD-L1 inhibitors in the treatment of malignant solid tumors. METHODS Randomized controlled trials （RCTs） on apatinib combined with PD-1/PD-L1 inhibitors （combination group） versus monotherapy （apatinib or PD-1/PD-L1）combined with （or） chemotherapy/other treatments （control group） in the treatment of malignant solid tumors were collected from PubMed， Web of Science， Embase， Cochrane Library， CNKI， VIP， Wanfang Data and China Biomedical Literature Database. The search time limit was from the establishment of the databases to May 2025. After literature screening， data extraction and literature quality evaluation， meta-analysis was performed using RevMan 5.3 and Stata 14.0. RESULTS A total of 28 RCTs involving 2 974 patients were included. The objective response rate [RR＝1.639， 95%CI（1.452，1.851）， P＜0.000 01]， disease control rate [RR＝1.284， 95%CI（1.178，1.399）， P＜0.000 01] and CD3+， CD4+， CD4+/CD8+ as well as the incidence of ADR such as hypertension， fatigue， proteinuria， thrombocytopenia were significantly higher in the combination group than control group （P＜0.05 or P＜0.000 01）. The progressive disease rate [RR＝ 0.497， 95%CI（0.437， 0.566）， P＜0.000 01] and serum tumor + marker levels and CD8 were significantly lower in the combination group than control group （P＜0.05 or P＜0.000 01）. Subgroup analysis results of different types of tumors showed that the objective response rate and disease control rate were significantly higher in the combination group than control group （P＜0.05）. The results of sensitivity analysis showed that the stability of this study was good. The results of publication bias analysis showed that there was a high possibility of publication bias in this study. CONCLUSIONS Apatinib combined with PD-1/ PD-L1 inhibitors has a significant efficacy in the treatment of different types of tumors， but attention should be paid to the occurrence of hypertension， fatigue， proteinuria and thrombocytopenia.

Objective To evaluate the surgical efficacy of unilateral pneumonectomy for the treatment of tuberculous destroyed lung, analyze the causes of severe postoperative complications, and explore clinical management strategies. Methods A retrospective analysis was conducted on the clinical data of patients with tuberculous destroyed lung who underwent unilateral pneumonectomy at the Public Health Clinical Center of Chengdu from 2017 to 2023. Postoperative severe complications were statistically analyzed. Patients were divided into a non-severe complication group and a severe-complication group, and the causes, management, and outcomes of complications were analyzed. Results A total of 134 patients were included, comprising 69 males and 65 females, with a mean age of 17-73 (40.43±12.69) years. There were 93 patients undergoing left pneumonectomy and 41 patients undergoing right pneumonectomy. Preoperative sputum smear was positive in 35 patients, all of which converted to negative postoperatively. There were 58 patients with hemoptysis preoperatively, and none experienced hemoptysis postoperatively. Postoperative incisional infection occurred in 8 (5.97%) patients, and postoperative pulmonary infection in 26 (19.40%) patients. Severe postoperative complications occurred in 17 (12.69%) patients, including empyema in 9 (6.72%) patients, bronchopleural fistula with empyema in 1 (0.75%) patient, severe pneumonia in 3 (2.24%) patients, postpneumonectomy syndrome in 1 (0.75%) patient, chylothorax in 1 (0.75%) patient, ketoacidosis in 1 (0.75%) patient, and heart failure with severe pneumonia in 1 (0.75%) patient. Perioperative mortality occurred in 2 (1.49%) patients, both of whom underwent right pneumonectomy. Multivariate logistic regression analysis revealed that a history of ipsilateral thoracic surgery, concomitant Aspergillus infection, and greater blood loss were independent risk factors for severe complications following unilateral pneumonectomy for tuberculous destroyed lung (P<0.05). Conclusion Unilateral pneumonectomy for patients with tuberculous destroyed lung can significantly improve the clinical cure rate, sputum conversion rate, and hemoptysis cessation rate. However, there is a certain risk of severe perioperative complications and mortality, requiring thorough perioperative management and appropriate management of postoperative complications.

The diagnostic frequency of multiple pulmonary tumor nodules has increased significantly in clinical practice. Among patients with multiple pulmonary nodules, distinguishing between separate primary lung carcinomas and intrapulmonary metastases is critical for accurate tumor staging, therapeutic decision-making, and prognostic evaluation. The consensus document "Differentiating separate primary lung adenocarcinomas from intrapulmonary metastases with emphasis on pathological and molecular considerations: Recommendations from the International Association for the Study of Lung Cancer Pathology Committee" highlights the pivotal role of integrated pathological and molecular analyses in diagnosing and differentiating primary lung adenocarcinomas from intrapulmonary metastatic lesions. It further proposes a combined four-step histologic and molecular classification algorithm for addressing multiple pulmonary tumor nodules of adenocarcinoma histology, providing clinicians with enhanced diagnostic tools to refine staging accuracy, guide therapeutic strategies, and improve prognostic predictions for lung adenocarcinoma. Building on current advancements in global research, this article offers a comprehensive interpretation of the consensus recommendations.