Pars plana vitrectomy for retinal detachment using perfluoro-n-octane as intraoperative tamponade:a multicenter,randomized,non-inferiority trial

AIM:To evaluate the efficacy and safety of perfluoro-n-octane(PFO)for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy(PPV)in management of retinal detachment.METHODS:This multicenter,prospective,randomized,double-masked,parallel-controlled,non-inferiority trial was conducted in three ophthalmology clinical centers in China.Patients with retinal detachment,who were eligible for PPV were consecutively enrolled.Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio.Best-corrected visual acuity(BCVA),intraocular pressure(IOP)measurement,and dilated fundus examination were performed preoperatively and at 1,7±1,28±3d postoperatively.The primary outcome was complete retinal reattachment rate at postoperative day one.The non-inferiority margin was set at 9.8%.The secondary outcomes included intraoperative retinal reattachment rate,and mean changes in IOP and BCVA from baseline to 1,7±1,28±3d postoperatively,respectively.Safety analyses were presented for all randomly assigned participates in this study.RESULTS:Totally 124 eligible patients completed the study between Mar.14,2016 and Jun.7,2017.Sixty of them were randomly assigned to the PFO for ophthalmic surgery group,and 64 were assigned to the F-Octane group.Baseline characteristics were comparable between the two groups.Both groups achieved 100%retinal reattachment at postoperative day one(difference 0,95%CI:-6.21%to 5.75%,P=1).The pre-defined noninferiority criterion was met.No significant difference was observed in intraoperative retinal reattachment rate(difference 1.77%,P=0.61),mean changes in IOP(difference 0.36,-0.09,2.22 mm Hg at 1,7±1,28±3d postoperatively,with all P>0.05)and BCVA(difference 0.04,-0.02,0.06 logMAR at 1,7±1,28±3d postoperatively,all P>0.05)between the two groups.No apparent adverse events related to the utilization of PFO were reported.CONCLUSION:In patients with retinal detachment undergoing PPV,PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade,and both are safe and well-tolerated.

Estimated prevalence and sociodemographic correlates of mental disorders in medical students of Hebei Province,China:A crosssectional study

BACKGROUND In China,the identification rate and treatment rate of mental disorders are low,and there are few surveys on the prevalence of mental disorders among college students using diagnostic tools such as Mini-International Neuropsychiatric Interview(MINI),so the prevalence and treatment of mental disorders among college students are unclear.AIM To estimate prevalence of mental disorders among medical students in Hebei Province,and provide guidance for improving their mental health.METHODS This was a cross-sectional study based on an Internet-based survey.Three levels of medical students in Hebei Province were randomly selected(by cluster sampling)for screening.Using the information network assessment system,the subjects scanned the 2D code with their mobile phones,clicked to sign the informed consent,and answered a scale.A self-designed general status questionnaire was used to collect information about age,gender,ethnicity,grade,and origin of students.The MINI 5.0.was used to investigate mental disorders.Data analysis was performed with SPSS software.Statistically significant findings were determined using a two-tailed P value of 0.05.RESULTS A total of 7117 subjects completed the survey between October 11 and November 7,2021.The estimated prevalence of any mental disorders within 12 mo was 7.4%.Mood disorders were the most common category(4.3%),followed by anxiety disorders(3.9%);15.0%had been to psychological counseling,while only 5.7%had been to a psychiatric consultation,and only 10%had received drug therapy in the past 12 mo.CONCLUSION Although the estimated prevalence of mental disorders in medical students is lower than in the general population,the rate of adequate treatment is low.We determined that improving the mental health of medical students is an urgent matter.

Value of dual-energy CT virtual noncalcium in the diagnosis of sacroiliac joint bone marrow edema

Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average age of 34 years)who underwent MRI and DECT(Siemens Somatom definition force)examinations for the sacroiliac joints in our hospital from January 2019 to August 2020.After the DECT scan,the bone marrow pseudo-color map was obtained after VNCa processing.The bone marrow pseudo-color map was evaluated by two physicians.Take MRI test results as the gold standard,the application value of DECT VNCa technology in the diagnosis of sacroiliac joint BME was analyzed.Results:The positive predictive value(PPV),negative predictive value(NPV),sensitivity(Sen),specificity(Spe)and accuracy(Acc)of the qualitative diagnosis of iliac bone and sacral BME with DECT VNCa technology was:80.6%,85.2%,78.4%,86.8%,83.3%and 100%,64.9%,32.5%,100%,70.0%,respectively.The area of edema displayed by quantitative measurement of DECT VNCa image is smaller than the area measured by MRI image.The VNCa CT value(-71.66±72.97Hu)of the iliac edema area was higher than that of the non-edema area(-90.27±65.85Hu),and the VNCa CT value of the sacral edema area(-62.90±46.87Hu)was higher than that of the non-edema area(-101.08±134.02Hu),the best cut-off values(Cut-off values)for the quantitative diagnosis of iliac bone and sacral BME by VNCa are-66.40Hu and-50.60Hu,respectively.The curve of the receiver operating characteristic(ROC)of the iliac bone and sacrum area under the cure(AUC)is 0.720 and 0.706 respectively.There is a moderate negative correlation between the VNCa CT values of the ilium and sacrum in the edema area and the conventional CT values.Conclusion:The DECT VNCa technique has certain effectiveness in the diagnosis of sacroiliac joint BME,and its effectiveness in the diagnosis of ilium BME is better than sacrum.

Preclinical safety,effectiveness evaluation,and screening of functional bacteria for fecal microbiota transplantation based on germ-free animals

Fecal microbiota transplantation(FMT),also known as fecal bacterial therapy,is a treatment option that can quickly reconstruct the normal composition of intestinal microbes,and it has a good therapeutic effect on Clostridium difficile infection,as well as on other microecological disorders.However,the causal mechanism of FMT efficacy remains to be clarified,its safety is a major problem,and the standardization and acceptability of FMT need to be improved.This review summarizes its current research status and potential research areas that need to be strengthened,and proposes to clarify the safety of FMT and the causal relationship between FMT and therapeutic effectiveness based on germ-free animals.Meanwhile,the research system is combined with multiomics technology to screen the effective bacteria in FMT,and develop standard,safe,effective and controllable flora of FMT.

CircTUBD1 Regulates Radiation-induced Liver Fibrosis Response via a circTUBD1/micro-203a-3p/Smad3 Positive Feedback Loop

Background and Aims: Radiation-induced liver fibrosis (RILF), delayed damage to the liver (post-irradiation) re-mains a major challenge for the radiotherapy of liver ma-lignancies. This study investigated the potential function and mechanism of circTUBD1 in the development of RILF. Methods: By using a dual luciferase assay, RNA pull- down assays, RNA sequencing, chromatin immunoprecipi-tation (known as ChIP) assays, and a series of gain- or loss-of-function experiments, it was found that circTUBD1 regulated the activation and fibrosis response of LX-2 cells induced by irradiation via a circTUBD1/micro-203a-3p/ Smad3 positive feedback loop in a 3D system. Results: Knockdown of circTUBD1 not only reduced the expression of α-SMA, as a marker of LX-2 cell activation, but also significantly decreased the levels of hepatic fibrosis mol-ecules, collagen type I alpha 1 (COL1A1), collagen type III alpha 1 (COL3A1), and connective tissue growth factor (CTGF) in a three-dimensional (3D) culture system and RILF model in vivo. Notably, knockdown of circTUBD1 al-leviated early liver fibrosis induced by irradiation in mice models. Conclusions: This study is the first to reveal the mechanism and role of circTUBD1 in RILF via a circTUBD1/ micro-203a-3p/Smad3 feedback loop, which provides a novel therapeutic strategy for relieving the progression of RILF.

Effect of Stokes number on energy modulation of the fluid in turbulent particle-laden channel flows

The effect of Stokes number on the kinetic energy(KE)budget in particle-laden turbulent channel flows is examined by conducting two-way coupled direct numerical simulations using the Eulerian-Lagrangian approach.The friction Reynolds number of the single phase channel flow is Re_(τ)=180,the particle mass loading and volume fraction areφ_(m)=0.2,φ_(v)≈10−4,and the Stokes numbers range from St^(+)=14–92.The statistics show that due to the presence of solid particles,the mean velocity is reduced in the vicinity of the wall but enhanced in the outer region,and the off-streamwise intensity of fluctuated velocity and the Reynolds stress are reduced in the whole channel.The analysis on the budgets of turbulent kinetic energy(TKE)finds that the presence of particles induces a significant reduction on both the production and dissipation rates.With increasing Stokes number St^(+),both the production and dissipation rates exhibit non-monotonical trends,i.e.,both initially decrease for St^(+)<40 and then transit to growth after St^(+)>40.This suggests that the particle-induced suppression on TKE production and dissipation is the strongest nearly at St^(+)=40.It is also found that particles act as an additional sink/source term in the budgets of both mean-flow kinetic energy(MKE)and TKE.In addition,we investigate the influence of St^(+)on the“zero point”which indicates the balance of exchanging energy between the particle and fluid phases.It is shown that with increasing St^(+),the“zero point”moves toward the wall,suggesting that the position of perfect following between particle and fluid is closer to the wall with larger St^(+).The present results reveal the Stokes number effects on the spatial transport mechanisms of MKE,TKE in turbulent channel flows laden with inertial particles.

Comprehending the therapeutic effects of stereotactic body radiation therapy for small hepatocellular carcinomas based on imagings

Surgical resection or radiofrequency ablation(RFA)is considered first-choice treatment for small hepatocellular carcinomas(HCCs).When a patient has a small HCC that is inoperable or unsuitable for RFA,what are alternative treatments?Some oncologists recommend transarterial chemoembolization(TACE),chemotherapy,molecular-targeted therapy,or immunotherapy.However,these treatments have minimally beneficial effects in small HCCs.Stereotactic body radiation therapy(SBRT)is a liver-directed radical therapy for small HCCs,with treatment outcomes similar to those for surgical resection or RFA,but many oncologists do not comprehend its efficacy or accept this therapy.We herein discuss 11 typical patients who received SBRT for various indications:refusal to undergo resection or RFA;surgical resection or RFA considered difficult or unfeasible;residual cancer after surgical resection or RFA or incomplete iodized oil retention after TACE;or tumor recurrence after resection or RFA.We describe each case,including the radiation field,tumor radiation dose,and response to SBRT in both the tumor and liver parenchyma.These clinical data should help readers understand this new therapeutic technique.We also conducted a literature review and found evidence to support survival benefit with SBRT,including good three-and five-year overall survival rates.The purpose of this article is to encourage readers to accept the concept that SBRT is a low-toxicity and effective therapeutic option for patients with small HCCs,which offers substantial local control and improved overall survival,especially for patients with a tumor that is unresectable or unsuitable for RFA,residual tumor after local therapy,or intrahepatic recurrent tumor.