Objective To analyze the causal relationship between obesity and central retinal artery occlusion(CRAO)based on body mass index(BMI),which is commonly used to measure obesity,and Mendelian randomization(MR)method.Methods Two-sample MR analysis was performed using summary statistics from genome-wide associa-tion studies.Exposed genetic tools were divided into the men group(n=60 586,SNP=2 736 876,European men)and women group(n=171 977,SNP=2 494 613,European women);CRAO was selected as the outcome.The instrumental variable for BMI came from the Integrative Epidemiology Unit(IEU)publicly available data;the outcome CRAO data came from the FinnGen database.Inverse variance weighting(IVW)and weighted median(WM)were used to analyze the poten-tial relationship between BMI and CRAO.Results IVW showed that the increased BMI level significantly increased the risk of CRAO in men[OR=4.57,95％CI:1.32-15.82,P=0.016]and the risk of CRAO in women[OR=3.48,95％CI:1.40-8.63,P=0.007].Meanwhile,the WM and MR-Egger analysis results supported the above conclusions.In addition,there was no heterogeneity or pleiotropy in the results of this study.Conclusion The increase in BMI is positively corre-lated with the occurrence of CRAO.This study provides an effective CRAO prevention strategy for asymptomatic patients with elevated BMI levels.

Flanged intrascleral intraocular lens implantation has become one of the mainstream treatment solutions for aphakia in clinical practice due to its ability to avoid dislocation of the intraocular lens,or subluxation caused by suture degradation or breakage,as well as the ability to eliminate complications such as inflammation or infection caused by su-tures,and the significant improvement in postoperative vision for patients.However,there has been no systematic analysis of the factors that may lead to postoperative refractive prediction errors in China.This article analyzes the possible prob-lems of flanged intrascleral intraocular lens implantation and the reasons for postoperative refractive prediction errors,in order to provide reference for clinical work.

Objective:Mendelian randomization (MR) was used to analyze the potential relationship between blood pressure and proliferative diabetic retinopathy (PDR).Methods:Two-sample MR analysis was performed using summary statistics from genome-wide association studies. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were selected as the exposure, PDR as the outcome. The instrumental variable of SBP and DBP came from the publicly available data of the the UK Medical Research Council Comprehensive Epidemiology Unit and Neale Laboratory; the outcome data (8 681 cases in the case group, 204 208 cases in the control group, European population) are from the FinnGen database. Inverse variance weighting (IVW) and weighted median (WM) were used to analyze the potential relationships between SBP, DBP and PDR.Results:MR analysis showed that IVW [SBP: odds ratio ( OR)=1.36, 95% confidence interval ( CI) 1.17-1.57, P= 4.22E-05; DBP: OR=1.29, 95% CI 1.11-1.51, P=8.6E-04], WM (SBP: OR=1.33, 95% CI 1.07-1.66, P=0.009; DBP: OR=1.28, 95% CI=1.03-1.59, P=0.002). The results showed that elevated SBP and DBP increased the risk of PDR. Conclusion:Blood pressure (SBP, DBP) change is positively correlated with the risk of PDR.

ObjectiveTo evaluate the clinical effectiveness and safety of Bairui Granules （百蕊颗粒） in the treatment of acute pharyngitis with wind-heat syndrome. MethodsA multicenter， double-blind， double-simulation， randomised controlled trial was conducted， in which 162 patients with acute pharyngitis and wind-heat syndrome from 7 centers were recruited， and each center was divided into trial group and control group on the ratio of 2∶1. In the trial group， 108 cases were orally administered with Bairui Granules plus Reyanning Granules （热炎宁颗粒） simulant， and in the control group， 54 cases were orally administered with Reyanning Granules plus Bairui Granules simulant for 5 days， with a follow-up visit on the 6th day. Full analysis set （FAS） analysis and per protocol set （PPS） were used for analysis， respectively. The primary efficacy index was the disappearance rate of sore throat after 5-day treatment； the secondary efficacy indexes were the disappearance rate of sore throat after 3-day treatment， as well as the visual analogue score （VAS） of sore throat before treatment， every day during the treatment， and follow-up on day 6， and the traditional Chinese medicine （TCM） syndrome score was performed before treatment and at the follow-up on day 6. The effectiveness on TCM syndrome was evaluated at the follow-up on day 6， and the changes of vital signs， blood routine， urine routine， liver functions， kidney function， the adverse events before and after the treatment were recorded， and safety analysis set （SS） was analysed. Results162 patients entered the FAS and SS analyses， and 158 cases （105 cases in the trial group and 53 cases in the control group） entered the PPS analysis. FAS analysis showed that the disappearance rate of sore throat after 5-day treatment was 80.56% （87/108） in the trial group and 64.81% （35/54） in the control group， and the difference between groups was statistically significant （χ² = 5.10， P = 0.0239）. PPS analysis showed that the disappearance rate of sore throat after 5-day treatment was 80.00% （84/105） in the trial group and 64.15% （34/53） in the control group， and the difference between groups was statistically significant （χ² =4.85， P = 0.0277）. FAS and SS analyses both showed that the difference in disappearance rate of sore throat between groups on 3-day treatment was not statistically significant （P＞0.05）. Compared with those before treatment， the VAS scores of sore throat were lower in both groups during treatment on day 2， 3， 4， 5， and follow-up on day 6 （P＜0.01）， but the difference between groups at each time point was not statistically significant （P＞0.05）. TCM syndrome scores of both groups at the follow-up were lower than that before treatment， and those of the trial group were lower than those of the control group （P＜0.01）. The cure rate and effective rate of TCM syndrome of the trial group were significantly higher than those of the control group （P＜0.01）. There was no significant difference in blood routine， urine routine， liver function， kidney function between groups before and after treatment （P＞0.05）， and no serious adverse events occured in both groups. ConclusionBairui Granules showed clinical effectiveness in the treatment of acute pharyngitis of wind-heat syndrome， and it could significantly improve the clinical symptoms， accelerate the disappearance time of sore throat with good safety.

Objective:To investigate the influence of nutritional therapy on short-term efficacy of gastric cancer patients with malnutrition after radical gastrectomy.Methods:The prospec-tive randomized control study was conducted. The clinicopathological data of patients with malnutri-tion after radical resection of gastric cancer who were admitted to the Zhongshan Hospital of Fudan University from December 2020 to December 2022 were selected. Based on random number table, all patients were allocated into the nutritional therapy group and the control group. Patients in the nutritional therapy group were given dietary guidance and daily oral nutrition supplements for 90 days after discharge, while patients in the control group were only given the same dietary guidance. Observation indicators: (1) grouping situations of the enrolled patients; (2) follow-up; (3) comparison of nutritional indicators at 90 days after discharge; (4) comparison of inflammation and physical function indicators at 90 days after discharge; (5) comparison of clinical outcome indicators at 90 days after discharge. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(IQR), and non-parameter rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Comparison of ordinal data was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 187 patients were selected for eligibility. There were 131 males and 56 females, aged (65±12)years. Of the 187 patients, there were 95 patients in the nutritional therapy group and 92 patients in the control group, respectively. The gender (male, female), age, cases with cardiovascular complications, cases with respiratory complications, cases with diabetes, surgical methods (partial gastrectomy, total gastrectomy), tumor staging (Ⅰ stage, Ⅱ stage, Ⅲ stage), body mass, body mass index (BMI), skeletal muscle index, albumin (Alb), hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR), 6-minutes walking distance, grip strength were 68, 27, (64±12)years, 21, 4, 7, 59, 36, 17, 27, 51, (59±11)kg, (21.5±3.1)kg/m 2, (42±7)cm 2/m 2, (39±5)g/L, (112±25)g/L, 2.3(8.0), (456±97)m, (29±8)kg in patients of the nutritional therapy group, versus 63, 29, (66±13)years, 22, 3, 9, 56, 36, 14, 24, 54, (58±11)kg, (21.1±2.9)kg/m 2, (42±7)cm 2/m 2, (39±4)g/L, (111±26)g/L, 2.2(8.4), (459±98)m, (29±8)kg in patients of the control group, showing no significant difference in the above indicators between the two groups ( χ2=0.21, t=-1.29, χ2=0.09, 0, 0.35, 0.03, 0.51, t=0.80, 0.85, 0.19, 0.14, 0.16, Z=-0.28, t=-0.17, 0.43, P>0.05). (2) Follow-up. All 187 patients were followed up for 90 days after surgery. During the follow-up period, all patients had good compliance and were able to follow the dietary guidance. Five patients in the nutrition therapy group experienced diarrhea and nausea adverse reactions, which were relieved after symptomatic treatment. No adverse reactions were found in the control group. (3) Comparison of nutritional indicators at 90 days after discharge. The body mass, body mass loss, BMI, skeletal muscle index, Alb, Hb were (58±10)kg, 2(6)kg, (21.0±2.9)kg/m 2, (41±7)cm 2/m 2, (41±4)g/L, (125±18)g/L in patients of the nutritional therapy group, versus (56±10)kg, 3(6)kg, (20.4±2.7)kg/m 2, (39±7)cm 2/m 2, (41±4)g/L, (121±21)g/L in patients of the control group. There were significant differences in body mass loss and skeletal muscle index between the two groups ( Z=-4.70, t=2.39, P<0.05), and there was no significant difference in body mass, BMI, Alb, and Hb ( t=1.30, 1.51, 0.80, 1.32, P>0.05). (4) Comparison of inflammation and body function indicators at 90 days after discharge. The NLR, 6-minutes walking distance, grip strength were 2.1(5.1), (478±99)m, and (33±9)kg in patients of the nutritional therapy group, versus 2.2(5.7), (465±96)m, (30±8)kg in patients of the control group. There was a significant difference in grip strength between the two groups ( t=2.08, P<0.05), and there were no significant difference in NLR and 6-minutes walking distance ( Z=-1.28, t=0.91, P>0.05). (5) Comparison of clinical outcome indicators at 90 days after discharge. The quality of life score and readmission rate were (79±14)points, 4.2%(4/95) in patients of the nutritional therapy group, versus (78±16)points, 6.5%(6/92) in patients of the control group, showing no significant difference in the above indicators between the two groups ( t=0.58, χ2=0.14, P>0.05). Conclusion:Nutritional therapy with daily oral nutrition supplements can improve the short-term nutritional status and body function of patients with malnutrition after radical gastrectomy for gastric cancer.

The occurrence and development of myopia is closely related to scleral remodeling. Therefore, in order to effectively prevent and cure myopia, it is very important to clarify the mechanism of scleral remodeling. In recent years, Chinese scholars have found that endoplasmic reticulum stress can regulate the expression of apoptotic proteins through the inositol demand protein-1/X box binding protein-1 pathway in the unfolded protein response, thus it is involved in regulating the state of scleral fibroblasts under hypoxia and regulating the occurrence and development of scleral remodeling. At the same time, some studies have found that inhibiting and knocking out protein kinase RNA-like endoplasmic reticulum kinase and activated transcription factor 6 in endoplasmic reticulum stress can effectively inhibit the growth of ocular axis. This proves that endoplasmic reticulum stress plays an important role in the occurrence and development of scleral remodeling. However, the comprehensive analysis of endoplasmic reticulum stress and scleral remodeling has not been reported at home and abroad. In-depth analysis of the relationship between endoplasmic reticulum and scleral remodeling is of great significance for the follow-up analysis and study of the mechanism of scleral remodeling.

Malnutrition and dehydration are prevalent in the elderly poplulation, and obesity is also a growing problem, which pose a serious challenge to the nutritional management in geriatrics. In order to better guide clinical practice, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the practical guideline on clinical nutrition and hydration in geria-trics on March 5, 2022. This guideline provides 82 recommendations on clinical nutrition and hydration in geriatrics based on clinical practicability, covering basic problems and general prin-ciples, prevention and treatment of malnutrition/nutri-tional risk, prevention and treatment of specific diseases, as well as prevention and treatment of obesity, along with flow-charts, hoping to be convenient for doctors, nutritionists and nurses to use in clinical practice.

The European Society for Clinical Nutrition and Metabolism held the 43 rd annual academic conference online from September 9 to 14,2021. Based on reports from the con-ference, the authors launched a review on the current hot topics in clinical nutrition.

OBJECTIVE:To explore the clinical efficacy and safety of nalmefene combined with monosialotetrahexosylganglio-side sodium in the treatment of patients in brain tumor operation. METHODS:64 patients in brain tumor operation were randomly divided into observation group and control group,32 cases in each group. Control group received brain cell protection,reducing in-tracranial pressure,anti-infective,vasodilator and other conventional treatment;observation group additionally received 0.7μg/(kg· h) nalmefene combined with 100 mg/d monosialotetrahexosylganglioside sodium from the first day of operation,for continuous 7 d. The plasma cortisol,adrenocorticotropic hormone (ACTH) before and 3,7 d after treatment,changes of serum IL-6,TNF-αand Barthel index (BI) in 2 groups were observed,improvement of neurological function and ADR were observed;Karnofsky (KPS)score was determined after 90 d follow-up used to assess the patient’s ability to take care of themselves. RESULTS:After treatment,plasma cortisol and ACTH content,serum TNF-αand IL-6 levels in 2 groups significantly decreased than before,the dif-ference was statistically significant(P<0.05);cortisol,ACTH and TNF-α levels 3,7 d after treatment,IL-6 level 7 d after treat-ment in observation group decreased more significantly than control group,the differences were statistically significant(P<0.05). After treatment,BI score in 2 groups significantly increased,and observation group increased more significantly than control group,the differences were statistically significant (P<0.05). 7 d after treatment,improvement rate of neurological function was 50.00%,which was significantly higher than that of the control group(18.75%),the difference was statistically significant(P<0.05). There was no significant ADR occurred of 2 groups in the study. Following-up for 90 d,the KPS score in observation group with not less than 70 points accounted for 71.88%,which was significantly higher than the control group(46.87%),the difference was statistically significant (P<0.05). CONCLUSIONS:Nalmefene combined with monosialotetrahexosylganglioside sodium can promote the recovery of patients in brain tumor operation,reduce cortisol,ACTH,IL-6 and TNF-α levels and improve prognosis of patients.

Objective To investigate factors affecting the metastasis of lymph nodes around the root of inferior mesenteric artery(IMA) in rectal cancer,and the significance of root lymph nodes dissection of IMA in radical surgery for rectal cancer.Methods Clinicopathological data of 105 rectal cancer patients undergoing root lymph node dissection of IMA during radical resection in Peking University First Hospital from January 2005 to December 2008 were analyzed retrospectively.Rectal cancer patients without root lymph node dissection of IMA during the same period served as control.Results were compared between these two groups for survival and local recurrence rates.Results The rate of lymph node metastasis around the origin of IMA was 9.5％ (10/105).The five-year survival rate in patients with IMA root nodal dissection was 71.3％,and that without was 70.6％ (P =0.995),while the local recurrence was respectively 1.9％ and 7.4％ (P ＜ 0.05).In multivariate analyses,IMA root nodal metastasis occurred more frequently in patients with pT3 and pT4 tumor(Wald =5.764,P ＜ 0.05) and poorly differentiated tumor(Wald =7.818,P ＜ 0.05).Conclusions Root lymph nodes dissection of IMA could not increase five-year survival rate,but it could reduce local recurrence rate in patients with rectal cancer.In radical surgery of rectal cancer,lymphadenectomy of IMA root should be performed in patients with T3 and T4 tumor with poorly differentiated tumor,so as to reduce local recurrence rate.