The Clinical Value of Ultrasound Image Texture Analysis in the Diagnosis of Uterine Adhesions

Purpose: This review examines the diagnostic value of transvaginal 3D ultrasound image texture analysis for the diagnosis of uterine adhesions. Materials and Methods: The total clinical data of 53 patients with uterine adhesions diagnosed by hysteroscopy and the imaging data of transvaginal three-dimensional ultrasound from the Second Affiliated Hospital of Chongqing Medical University from June 2022 to August 2023 were retrospectively analysed. Based on hysteroscopic surgical records, patients were divided into two independent groups: normal endometrium and uterine adhesion sites. The samples were divided into a training set and a test set, and the transvaginal 3D ultrasound was used to outline the region of interest (ROI) and extract texture features for normal endometrium and uterine adhesions based on hysteroscopic surgical recordings, the training set data were feature screened and modelled using lasso regression and cross-validation, and the diagnostic efficacy of the model was assessed by applying the subjects’ operating characteristic (ROC) curves. Results: For each group, 290 texture feature parameters were extracted and three higher values were screened out, and the area under the curve of the constructed ultrasonographic scoring model was 0.658 and 0.720 in the training and test sets, respectively. Conclusion Relative clinical value of transvaginal three-dimensional ultrasound image texture analysis for the diagnosis of uterine adhesions.

Donor-derived CD 19 CAR-T Cells versus Chemotherapy Plus Donor Lymphocyte Infusion for Treatment of Recurrent CD 19-positive B-ALL after Allogeneic Hematopoietic Stem Cell Transplantation

Objective:This study aimed to compare the efficacy of anti-CD19 chimeric antigen receptor T cells(CAR-T cells)versus chemotherapy plus donor lymphocyte infusion(chemo-DLI)for treating relapsed CD 19-positive B-cell acute lymphoblastic leukemia(B-ALL)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Clinical data of 43 patients with B-ALL who relapsed after allo-HSCT were retrospectively analyzed.Twenty-two patients were treated with CAR-T cells(CAR-T group),and 21 with chemotherapy plus DLI(chemo-DLI group).The complete remission(CR)and minimal residual disease(MRD)-negative CR rates,leukemia-free survival(LFS)rate,overall survival(OS)rate,and incidence of acute graft-versus-host disease(aGVHD),cytokine release syndrome(CRS)and immune effector cell-associated neurotoxicity syndrome(ICANS)were compared between the two groups.Results:The CR and MRD-negative CR rates in the CAR-T group(77.3%and 61.5%)were significantly higher than those in the chemo-DLI group(38.1%and 23.8%)(P=0.008 and P=0.003).The 1-and 2-year LFS rates in the CAR-T group were superior to those in the chemo-DLI group:54.5%and 50.0%vs.9.5%and 4.8%(P=0.0001 and P=0.00004).The 1-and 2-year OS rates in the CAR-T versus chemo-DLI group were 59.1%and 54.5%vs.19%and 9.5%(P=0.011 and P=0.003).Six patients(28.6%)with grade 2-4 aGVHD were identified in the chemo-DLI group.Two patients(9.1%)in the CAR-T group developed grade 1-2 aGVHD.Nineteen patients(86.4%)developed CRS in the CAR-T group,comprising grade 1-2 CRS in 13 patients(59.1%)and grade 3 CRS in 6 patients(27.3%).Two patients(9.1%)developed grade 1-2 ICANS.Conclusion:Donor-derived anti-CD19 CAR-T-cell therapy may be better,safer,and more effective than chemo-DLI for B-ALL patients who relapse after allo-HSCT.

Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas

BACKGROUND Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery.Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples.AIM To investigate the correlations among mindfulness,marital quality,anxiety,and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas.METHODS A cross-sectional study was conducted.The self-administered questionnaire was submitted online through smartphones.The levels of mindfulness,anxiety,depression,and marital quality were respectively investigated by the mindful attention awareness scale(MAAS),the self-rating anxiety scale(SAS),the selfrating depression scale(SDS),and the marriage perception scale(MPS)in these enrolled Han and Tujia primiparas.RESULTS No statistical significance was observed in the prevalence of postpartum anxiety and depression,nor scores of MAAS and MPS-Total in different regions or ethnicities(P>0.05).However,MPSMarital interaction(P<0.05),MPS-Family relationship(MPS-FR)(P<0.01),and MPS-Marital conflict(MPS-MC)(P<0.01)scores of urban primiparas were higher than those of rural primiparas.The MPS-MC score of Han primiparas was higher than that of Tujia primiparas(P<0.05).Negative correlations were observed between MAAS and SAS(r=-0.457,P<0.01),and MAAS and SDS(r=-0.439,P<0.01).SAS has revealed a highly positive correlation with SDS(r=0.720,P<0.01)and a weak negative correlation with MPS(r=-0.200,P<0.05).Besides,a weak negative correlation was observed between MAAS and MPS-MC(r=-0.184,P<0.05),and a weak positive correlation was noticed between SAS and MPS-MC(r=-0.225,P<0.01).Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety(P<0.05,95%CI:-0.384 to 0.033),MPS-MC and postpartum anxiety(P<0.01,95%CI:0.027-0.193),MPS-FR and postpartum depression(P<0.05,95%CI:-0.365 to 0.031),and MPS-MC and postpartum depression(P<0.01,95%CI:0.022-0.206).CONCLUSION Mindfulness demonstrates negative correlations with marital conflict,postpartum anxiety and depression,and it may have cross-ethnic and trans-regional characteristics.Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study,it demonstrates a full mediation effect on the relationships between family relationships,marital conflict,and postpartum anxiety and depression.

The Applications of Mitoxantrone and Its Liposome in Adult Acute Myeloid Leukemia

Acute myeloid leukemia (AML), a rapidly progressing hematopoietic malignancy, can only be cured hopefully by hematopoietic stem cells transplantation (HSCT). Before HSCT, we usually exert effects by attempting certain regimens to induce these tumor cells to death. Administered in AML patients, the classic “3 + 7” intensive induction regimen including anthracyclines and cytarabine is recommended by guidelines worldwide. However, conventional regimens consist of anthracyclines, a category of drug limited by cumulative, dose-related, progressive myocardial damage and congestive heart failure occurs when its total doses break through the cut-off. Based on this background, mitoxantrone (MIT), an anthraquinone, was developed to a new form to reduce cardiotoxicity. Meanwhile, the nanomedicine, mitoxantrone liposome (Lipo-MIT), was characterized by improved bioavailability and limited toxicity. This drug has great therapeutic potential, but different side effects. We conclude the overall history and development of MIT and Lipo-MIT, which show controversial efficacy of MIT compared to doxorubicin and therapeutic potential of Lipo-MIT. This article reviewed the application of MIT and liposome forms in adult AML patients. .

Development and validation of a risk prediction model for repeated indwelling urinary catheterization in patients with cervical cancer after surgery

Objective:To study the factors influencing secondary indwelling catheterisation after cervical cancer surgery and to develop a predictive risk model.Methods:A total of 260 patients in a tertiary hospital in Chongqing were selected from January 2020 to December 2021 via convenience sampling.Relevant information of patients was recorded,including age;body mass index;history of hypertension and diabetes,bladder dysfunction,postoperative urinary retention,and postoperative urinary tract infection;Histology;staging;surgical approach;Operation time;Time of first remove of catheter;indwelling catheter days;Hospitalization days.Least absolute shrinkage and selection operator was used to reduce dimensionality and select patient characteristics,and multivariate analysis was performed based on the selected variables.Based on the outcome of analysis,a line chart model was developed for predicting the risk of secondary catheterization in patients with indwelling catheterization after radical cervical cancer surgery.The coefficient of conformity index(C-index)and calibration curves were used to evaluate the accuracy and fit.The model was internally validated via bootstrapping(1000 random samples),and the clinical utility of the model was assessed via decision curve analysis(DCA).Results:Four characteristic variables were selected,including preoperative bladder function,postoperative urinary tract infection,surgical approach,and Time of first remove of catheter.They are independent risk factors affecting urinary tract.The risk prediction model exhibited good discrimination performance with a C-index of 0.722(95%CI,0.661-0.783)and was well calibrated.The C-index was 0.708 in internal validation analysis.DCA showed that the risk model was clinically useful for predicting secondary catheterization,and clinical benefits were observed at the decision threshold of≥11%.Conclusion:A novel model was developed to predict the risk of secondary catheterization.The model was based on preoperative bladder dysfunction,postoperative urinary tract infection,surgical approach,and number of days since the removal of the primary catheter.

Safety and efficacy of modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension

BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical safety and efficacy of modified endoscopic ultrasound(EUS)-guided selective N-butyl-2-cyanoacrylate(NBC)injections for gastric variceal hemorrhage in LSPH.METHODS A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted.Preoperative EUS evaluations were performed.Enrolled patients were divided into modified and conventional groups according to the NBC injection technique.The final selection of NBC injection technique depended on the patients’preferences and clinical status.The technical and clinical success rates,operation time,NBC doses,perioperative complications,postoperative hospital stay,and recurrent bleeding rates were analyzed,respectively.RESULTS A total of 27 patients were enrolled.No statistically significant differences were observed between the two groups regarding baseline characteristics.In comparison to patients in the conventional group,patients in the modified group demonstrated significantly reduced NBC doses(2.0±0.6 mL vs 3.1±1.0 mL;P=0.004)and increased endoscopic operation time(71.9±11.9 min vs 22.5±6.7 min;P<0.001).Meanwhile,the two groups had no significant difference in the technical and clinical success rates,perioperative complications,postoperative hospital stay,and recurrent bleeding rates.CONCLUSION Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage,with advantages of reduced injection dose and no radiation risk.Drawbacks were time consumption and technical challenge.

Computed tomography-based nomogram of Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction to predict response to docetaxel, oxaliplatin and S-1

BACKGROUND Neoadjuvant chemotherapy(NAC)has become the standard care for advanced adenocarcinoma of esophagogastric junction(AEG),although a part of the patients cannot benefit from NAC.There are no models based on baseline computed tomography(CT)to predict response of Siewert type II or III AEG to NAC with docetaxel,oxaliplatin and S-1(DOS).AIM To develop a CT-based nomogram to predict response of Siewert type II/III AEG to NAC with DOS.METHODS One hundred and twenty-eight consecutive patients with confirmed Siewert type II/III AEG underwent CT before and after three cycles of NAC with DOS,and were randomly and consecutively assigned to the training cohort(TC)(n=94)and the validation cohort(VC)(n=34).Therapeutic effect was assessed by disease-control rate and progressive disease according to the Response Evaluation Criteria in Solid Tumors(version 1.1)criteria.Possible prognostic factors associated with responses after DOS treatment including Siewert classification,gross tumor volume(GTV),and cT and cN stages were evaluated using pretherapeutic CT data in addition to sex and age.Univariate and multivariate analyses of CT and clinical features in the TC were performed to determine independent factors associated with response to DOS.A nomogram was established based on independent factors to predict the response.The predictive performance of the nomogram was evaluated by Concordance index(C-index),calibration and receiver operating characteristics curve in the TC and VC.RESULTS Univariate analysis showed that Siewert type(52/55 vs 29/39,P=0.005),pretherapeutic cT stage(57/62 vs 24/32,P=0.028),GTV(47.3±27.4 vs 73.2±54.3,P=0.040)were significantly associated with response to DOS in the TC.Multivariate analysis of the TC also showed that the pretherapeutic cT stage,GTV and Siewert type were independent predictive factors related to response to DOS(odds ratio=4.631,1.027 and 7.639,respectively;all P<0.05).The nomogram developed with these independent factors showed an excellent performance to predict response to DOS in the TC and VC(C-index:0.838 and 0.824),with area under the receiver operating characteristic curve of 0.838 and 0.824,respectively.The calibration curves showed that the practical and predicted response to DOS effectively coincided.CONCLUSION A novel nomogram developed with pretherapeutic cT stage,GTV and Siewert type predicted the response of Siewert type II/III AEG to NAC with DOS.

A model of five genes of tumor microenvironment predicts prognosis in Cholangiocarcinoma

Background:Cholangiocarcinoma(CCA)is highly malignant and has a poor prognosis has a high malignant degree and poor prognosis.The purpose of this study is to develop a new prognostic model based on genes related to the tumor microenvironment(TME).Methods:Derived from the discerned differentially expressed genes within The Cancer Genome Atlas(TCGA)dataset,this investigation employed the methodology of weighted gene co-expression network analysis(WGCNA)to ascertain gene co-expressed modules intricately linked to the Tumor Microenvironment(TME)among Cholangiocarcinoma(CCA)patients.The genes associated with prognosis,as identified through Cox regression analysis,were employed in the formulation of a predictive model.This model underwent validation,leading to the development of a risk score formula and nomogram.Concurrently,we validated the model’s reliability using data from CCA patients in the Gene Expression Omnibus(GEO)database(accession:GSE107943).Results:6139 DEGs were divided into 10 co-expressed gene modules using WGCNA.Among these,two modules(blue module with 832 genes and brown module with 1379 genes)showed high correlation with the TME.Five prognostic genes(BNIP3,COL4A3,SPRED3,CEBPB,PLOD2)were identified through Cox regression analysis,and a prognostic model and risk score formula were developed based on these genes.Risk score formula:Risk score=BNIP3×1.70520-COL4A3×2.39815+SPRED3×1.17936+CEBPB×0.40456+PLOD2×0.24785.Kaplan-Meier survival analysis revealed that the survival probabilities of the low-risk group were significantly higher than those of the high-risk group.Furthermore,the related evaluation indexes suggested that the model exhibited strong predictive ability.Conclusion:The prognostic model,based on five TME-related genes(BNIP3,COL4A3,SPRED3,CEBPB,PLOD2),could accurately assess the prognosis of CCA patients to aid in guiding clinical decisions.

Clinical outcomes of small incision lenticule extraction versus femtosecond laser-assisted LASIK for myopia: a Meta-analysis

AIM：To evaluate the possible differences in visual quality between small incision lenticule extraction（SMILE）and femtosecond laser in situ keratomileusis（FS-LASIK）for myopia.METHODS：A Meta-analysis was performed.Patients were from previously reported comparative studies treated with SMILE versus FS-LASIK.The Pub Med,EMBASE,Cochrane,Web of Science and Chinese databases（i.e.WANFANG and CNKI）were searched in Nov.of 2016 using Rev Man 5.1 version software.The differences in visual acuity,aberration and biomechanical effects within six months postoperatively were showed.Twenty-seven studies including 4223 eyes were included.RESULTS：No significant differences were observed between SMILE and FS-LASIK in terms of the proportion of eyes that lost one or more lines of corrected distance visual acuity after surgery（P=0.14）,the proportion of eyes achieving an uncorrected distance visual acuity of 20/20or better（P=0.43）,the final refractive spherical equivalent（P=0.89）,the refractive spherical equivalent within±1.00diopter of the target values（P=0.80）,vertical coma（P=0.45）and horizontal coma（P=0.06）.Compared with the FSLASIK group,total higher-order aberration（P〈0.001）and spherical aberration（P〈0.001）were higher and the decrease in corneal hysteresis（P=0.0005）and corneal resistance factor（P=0.02）were lower in the SMILE group.CONCLUSION：SMILE and FS-LASIK are comparable in efficacy,safety and predictability for correcting myopia.However,the aberration in the SMILE group is superior to that in the FS-LASIK group,and the loss of biomechanical effects may occur less frequently after SMILE than after FS-LASIK.

Tamsulosin Monotherapy Is Effective in Reducing Ureteral Stentrelated Symptoms:A Meta-analysis of Randomized Controlled Studies

This study aimed to evaluate the effectiveness of tamsulosin monotherapy for the treatment of ureteral stent-related symptoms(SRSs)and compare it with that of solifenacin monotherapy and combined therapy of tamsulosin and silifenacin.Randomized controlled trials(RCTs),which evaluated the effectiveness of tamsulosin for the treatment of SRSs,were searched from the databases PubMed,EMBASE and the Cochrane Library published up to November 2018.Eight RCTs involving 1087 participants were finally included in this meta-analysis.The results showed that tamsulosin monotherapy could significantly decrease the urinary symptoms[mean difference(MD)—7.56,95%confidence interval(CI)(-11.47,-3.65),P=0.0001]and body pain[MD-5.25,95%CI(-8.03,-2.46),P=0.0002],and improve the sexual performance[MD-1.06,95%CI(-1.89,-0.24),P=0.01]compared with the control group.Moreover,there was no significant difference between tamsulosin monotherapy and solifenacin monotherapy in all outcomes except for significantly better sexual performance in solifenacin group[MD 0.29,95%CI(0.06,0.51),P=0.01].In addition,the effectiveness of combined therapy of tamsulosin and solifenacin was not superior to that of tamsulosin monotherapy.Our study demonstrated that tamsulosin monotherapy was effective for the treatment of patients with SRSs;evident superiority could not be found for therapy of tamsulosin and solifenacin combined.

Factors influencing the short-term and long-term survival of hepatocellular carcinoma patients with portal vein tumor thrombosis who underwent chemoembolization

BACKGROUND The factors affecting the short-term and long-term prognosis of hepatocellular carcinoma(HCC) patients with portal vein tumor thrombosis(PVTT) receiving transarterial chemoembolization(TACE) are still unclear.AIM To clarify the predictors correlated with the short-term and long-term survival of HCC patients with PVTT who underwent TACE.METHODS The medical records of 181 HCC patients with PVTT who underwent TACE at the Second Affiliated Hospital of Chongqing Medical University from January 2015 to July 2019 were retrospectively analyzed. We explored the short-term and longterm prognostic factors by comparing the preoperative indicators of patients who died and survived within 3 mo and 12 mo after TACE. Multivariate analyses were conducted using logistic regression. The area under the receiver operating characteristic curve(area under curve) was used to evaluate the predictive ability of the factors related to the short-term and long-term prognosis.RESULTS The median survival time was 4.8 mo(range: 2.5-8.85 mo). The 3 mo, 6 mo, and 12 mo survival rates were 68.5%, 38.7%, and 15.5%, respectively. In multivariable analysis, total bilirubin, sex, and aspartate aminotransferase(AST) were closely linked to short-term survival. When AST ≥ 87 U/L and total bilirubin ≥ 16.15 μmol/L, the 3-mo survival rate after TACE was reduced significantly(P < 0.05). AST had the best predictive ability, followed by total bilirubin, while sex had the worst predictive ability for short-term survival area under curve: 0.763(AST) vs 0.707(total bilirubin) vs 0.554(sex)]. The long-term survival outcome was significantly better in patients with a single lesion than in those with ≥ three lesions(P = 0.009). Patients with massive block HCC had a worse long-term survival than patients with nodular and diffuse HCC(P = 0.001).CONCLUSION AST, total bilirubin, and sex are independent factors associated with short-term survival. The number of tumors and the gross pathological type of tumor are related to the long-term outcome.

Association between complement factor I gene polymorphisms and the risk of age-related macular degeneration:a Meta-analysis of literature

AIM： To systematically review the association between complement factors I （CFI） polymorphisms and age- related macular degeneration （AMD） and to explore whether CFI polymorphisms are associated with AMD, METHODS： Meta-analysis of articles published from 1995 to January 2015 of articles involved with AMD and polymorphisms of the CFI gene. Eligible data were pooled in a Meta-analysis, analyzing using STATA software （version 12.0）, Review Manager （version 5.2） and different models based on the heterogeneity of effect sizes. Egger＇s test, Begg＇s rank correlation methods were used to evaluate for publication bias.~ RESULTS： Thirteen articles were eligible, describing two loci polymorphisms of the CFI gene （of which 12 articles focus on rs10033900T〉C and 3 articles focus on rs2285714C〉T）. For rs10033900T〉C, the results of our study revealed that having a mutant allele C, TC, CC and TC＋CC was associated with a decreased risk of AMD in all population groups studied （C versus T models, OR=0.84, 95%Ch 0.72-0.99, P=0.04; TC versus TT models OR= 0.89, 95%Ch 0.88-0.99, P=0.04;CC versus ＂1-1＂ models, OR=0.76, 95%Ch 0.60-0.98, P=-0.03; TC＋CC versus TT models, OR=0.81, 95%Ch0.65-0.99, P=0.04）. We found that C allele were related to lower AMD risk in the Caucasian population by subgroup analysis, but there was no association with AMD under the allele and genotypes comparison in Asian studies. For rs2285714 C〉T, the TC, TT genotypes contributed to a higher risk of AMD, compared with the CC carriers and CT＋CC （OR=1.34, 95%Ch 1.09-1.63, P=0.004; OR=1.50, 95%Ch 1.25-1.80, P〈0.0001）. CONCLUSION： This Meta-analysis suggests that CFI rs10033900T〉C and rs2285714C〉T polymorphisms may contribute to AMD.

Inhibitory Effect of Diclofenac Sodium on the Proliferation of Rabbit Corneal Epithelial Cells in vitro

<Abstract>Purpose:To investigate the inhibitory effect of diclofenac sodium on rabbit corneal epithelial cells (RCECs) in vitro and explore its pharmacological mechanism. Methods: The fresh rabbit cornea was cultured to get the primary RCECs,and RCECs of passage 2 were used for the research. The cells were divided into experimental groups,the cells in which were incubated with different concentrations(18.18, 27.27, 36.36, 45.45, 54.55 μg/ml) of diclofenac sodium, and control group. The effect of diclofenac sodium on the proliferation of cells was measured by methyl thiazolyl thiazolium (MTT) assay 24, 48 and 72 h after incubation. While the RCECs were divided into experimental groups, the cells in which were incubated with 9 and 12.5 μg/ml diclofenac sodium, and control group. The cell cycle and apoptotic rate were observed by flow cytometer. Results:MTT assay showed that diclofenac sodium had obvious inhibitory effect on RCECs,and the inhibition rate was increasing along with the increase of the concentration of diclofenac sodium and the incubation time(P<0.05). Flow cytometer showed that after incubation with diclofenac sodium, the cells in G0/G1 phase were obviously increased, the apoptosis cusp and apoptotic rate were increased. Conclusion: Diclofenac sodium has obvious inhibitory effect on RCECs, which was dosage-dependent,and it may function by inducing cell apoptosis and ceasing cells cycles.

Therapeutic Effect and Safety of Ustekinumab for Plaque Psoriasis: A Meta-analysis

Objective To evaluate the efficacy and safety of ustekinumab in the therapy of plaque psoriasis. Methods Literatures published up to November 2013 were collected from Cochrane library, MEDLINE, and PubMed which were related with ustekinumab for plaque psoriasis. The efficacy was estimated using relative risk of Psoriasis Area and Severity Index(PASI) 75 response rate at the week 12 endpoint in clinical trials, and adverse effects were also analyzed. Meta-analysis was carried out by using Review Manager 5.1. Results Six randomized control trials consistent with the inclusion criteria were selected and reviewed. Ustekinumab 45 mg group and 90 mg group could get better therapeutic effect compared with the placebo group(all P<0.00001). Furthermore, ustekinumab 90 mg group was more effective than ustekinumab 45 mg group(P=0.01). Adverse effects in the 6 trials were mentioned including headache, upper respiratory tract infection, nasopharyngtis, infection, serious infection, cardiovascular events, and malignant tumors. There were no statistically significant differences of these adverse effects among three groups(all P>0.05), except that infection rate in ustekinumab 45 mg group was higher than the placebo group(P=0.02). Conclusions Ustekinumab is an effective and safe therapeutic method for plaque psoriasis. However, further longer time analysis of safety is needed.

Visual differences in topography-guided versus wavefront-optimized LASIK in the treatment of myopia: a Meta-analysis

AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases(i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA(version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed.RESULTS: Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity(UCVA) of 20/20 or better(P=0.377), gaining one line or more(P=0.05), postoperative cylinder(P=0.40), vertical coma(P=0.593) and horizontal coma(P=0.957). After TG ablation, the proportion of the patients’ eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO(P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent(MRSE;P=0.000) was lower, and UCVA(P=0.005) was better in the TG group. The higher-order aberrations(HOAs;P=0.000), spherical aberration(P=0.000) and coma(P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups.CONCLUSION: Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.

The Neutrophil/Lymphocyte Ratio is Associated with Different Stages of Development of Coronary Artery Disease

Introduction:Inflammation plays a role in coronary artery disease(CAD).The neutrophil/lymphocyte ratio(NLR),monocyte/lymphocyte ratio(MLR)and platelet/lymphocyte ratio(PLR)are blood parameters associated with inflammation.We aimed to perform a systematic comparison and study the predictive values of these inflammatory parameters with respect to CAD stage.Method:A total of 513 patients who had undergone coronary angiography(CAG)were retrospectively analyzed.Clinical status,lipid profiles,CAG scans and hematological parameters were collected.NLR,MLR and PLR were calculated.All patients were classified into a normal coronary group(n=133),coronary atherosclerosis(CA)group(n=149),chronic coronary syndrome(CCS)group(n=175)or acute myocardial infarction(AMI)group(n=56).NLR,MLR and PLR were compared among groups.Results:NLR and MLR were higher in the CCS and AMI groups.PLR was higher in the AMI group.The AMI group had higher NLR,PLR and MLR than the CCS group.Logistic regression analysis revealed that NLR(OR:1.227,95%CI:1.016–1.482.P<0.05)had a strong significant correlation with CAD.Area under the ROC curve of NLR was 0.580(95%CI=0.516–0.644)in predicting CCS and 0.727(95%CI=0.642–0.811)in predicting AMI.Conclusion:NLR may be associated with the occurrence and progression of CAD,and may serve as a marker of inflammation.

Effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19:A retrospective cohort study

BACKGROUND The effectiveness of adjunctive corticosteroid use in patients with coronavirus disease 2019(COVID-19)remains inconclusive.AIM To investigate the effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19.METHODS We conducted a retrospective analysis of the difference in several outcomes between patients with severe COVID-19 who received corticosteroid therapy(the corticosteroid group)and patients with severe COVID-19 who did not receive corticosteroid therapy(the non-corticosteroid group).RESULTS Seventy-five patients were included in this study.Of these,47 patients were in the corticosteroid group and 28 patients were in the non-corticosteroid group.There were no differences between the two groups in the total length of hospital stay,the length of intensive care unit stay,high-flow oxygen days,non-invasive ventilator days,invasive ventilation days,and mortality rate.Total lesion volume ratio,consolidation volume ratio and ground-glass opacity volume ratio in the corticosteroid group decreased significantly on day 14,while those in the noncorticosteroid group did not show a significant decrease.CONCLUSION Our results show that adjunctive corticosteroid use did not significantly improveclinical outcomes in severe COVID-19 patients,but might promote the absorptionof pulmonary lesions.Larger multicenter randomized controlled studies may beneeded to confirm this.

Comparison of Cardiac Structural Improvement in Patients with Primary Aldosteronism after Surgical Therapy and Drug Therapy: A Meta-Analysis

Background: At present, in clinical practice, patients with primary hyperaldosteronism (PA) are mainly treated by surgery or medical drugs (spironolactone/spironolactone, epridone, etc.). Some studies show that the left ventricular hypertrophy of patients can be significantly improved after treatment. However, at present, the relevant research is very limited, and there is still controversy on the improvement of cardiac structure and function between the two treatment methods. No reliable conclusions have been drawn. Objective: We conducted this meta-analysis to compare the improvement of cardiac structure of patients after surgical treatment and drug treatment, so as to clarify the efficacy of surgical treatment and drug treatment for PA patients. Methods: In order to examine the cardiac color ultrasound data of PA patients receiving surgical treatment and drug therapy (spironolactone, antisterone), randomized or observational studies were searched through Pubmed, Cochrane Library, and Embase. Meta-analysis was then carried out on the comprehensive and individual outcomes. The ROINBS-I scale is utilized to assess the offset risk of study inclusion. Outcomes: A total of nine studies involving 799 patients with PA into meta analysis, according to the results of the surgery in the treatment of patients with PA, left ventricular mass index (LVMI) changes in value (drop range) is significantly higher than drug therapy (Mean difference IV: —2.32, P In 6 studies, after surgical treatment of interventricular septal thickness (IVSD), changes in value (drop range) are also higher than drug therapy (Mean difference IV: —0.35, P In 2 studies, the surgical treatment of plasma aldosterone concentration (PAC) drop degree is superior to drug therapy (Mean difference IV: —12.63, P < 0.05), and blood pressure to improve the degree of surgery and drug treatment has no obvious difference. Conclusions: This meta-analysis result confirmed that after medical and surgical treatment of PA can obviously improve the patient’s blood pressure, and no difference between the two treatments. But for the heart structure improvement, including left ventricular hypertrophy and interventricular septum thickness, surgical treatment effect is significantly better than the medicine treatment, so the adrenalectomy can be used as unilateral PA optimal choice of treatment.

The Clinical Analysis of Bile Duct Injury during Laparoscopic Cholecystectomy

The study was to improve surgical safety and reduce the incidence of bile duct injury (BDI) during laparoscopic cholecystectomy. The clinical information of 31 cases with bile duct injury during Laparoscopic Cholecystectomy (LC) was analyzed retrospectively. Thirty patients with bile duct injury were divided into 5 types according to Bismuth typing, including: type I 9 cases, type II 12 cases, type III 4 cases, type IV 3 cases, type V 3 cases. After median follow-up of 48 months, 30 (97%) patients are alive and 29 (94%) remain in good general condition with normal liver function. One patient died from acute obstructive suppurative cholangitis (AOSC). One patient appeared to have pain under the xiphoid that was resolved after 3 months. Recurrent strictures following repair have developed in two (6%) patients with high injuries combined with right hepatic arterial injury. Appropriate surgical indications, handling Calot triangle carefully and correctly, and conversion to open surgery at the right moment are the keys of prevention and treatment of bile duct injury during LC.

A Case Report of Scrub Typhus: Secondary Acute Arrest of Hemopoiesis with Multiple Organ Dysfunction Syndromes

Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of hemopoiesis (AAH) always manifests in pancytopenia and with supportive treatment or inducement removal, the AAH patients would show significant improvement in blood routine for about a week. As a rapidly progressive and potentially life-threatening organ function disorder syndrome, multiple organ dysfunction syndrome (MODS) is often induced by many factors including infection, illness and injury. We received a rare case of scrub typhus rapidly presenting with AAH and MODS 2 weeks ago. The clinical data of a 32-year-old female with O. tsutsugamushi-induced AAH and MODS was summarized retrospectively and analyzed with a literature review. In this case, we selected tigecycline and moxifloxacin as treatment regimens for scrub typhus. When the potential infection was controlled, her pancytopenia and hepatic function rapidly improved in a few days.