Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic ...Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.展开更多
Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,m...Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.展开更多
Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAV...Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.展开更多
To improve the corrosion resistance of biodegradable Mg alloys,WE43 alloys were implanted with Fe,Ti,Zn and Zr ions at the same implantation dose.The surface morphology,valence state of elements,nano-hardness(NH),elas...To improve the corrosion resistance of biodegradable Mg alloys,WE43 alloys were implanted with Fe,Ti,Zn and Zr ions at the same implantation dose.The surface morphology,valence state of elements,nano-hardness(NH),elastic modulus(EM),degradation rate and in vitro cell experiments of the modified WE43 alloys were systematically studied.A modified layer composed of Mg,MgO,the implanted elements and their oxides was formed on the modified alloys.Since high-speed metal ions caused severe surface lattice damage,the surface hardness of the substrate considerable increased.Electrochemical tests demonstrated a substantial enhancement in the corrosion resistance of the modified alloys via the implantation of Ti and Zr ions,resulting in a reduction of the corrosion current density to 88.1±9.9 and 15.6±11.4μA cm^(−2),respectively,compared with the implantation of Fe and Zn ions.Biocompatibility tests showed that the implantation of Fe,Ti,Zn and Zr ions enhanced the anticoagulant and hemolytic resistance of the WE43 alloy.All surface-modified samples showed negligible cytotoxicity(0-1)at 12.5%extract concentration.Moreover,the alloys implanted with Fe,Ti and Zn ions significantly promoted proliferation of human umbilical vein endothelial cells(HUVEC)compared with the unmodified alloy.The results demonstrate that Ti ion implantation is the best choice for WE43 alloy modification to achieve outstanding corrosion resistance and biocompatibility.展开更多
Background Increased backfat thickness of sows in early gestation is negative to reproductive performance.Endometrial receptivity is an important determinant of reproductive success,but it is unclear whether the effec...Background Increased backfat thickness of sows in early gestation is negative to reproductive performance.Endometrial receptivity is an important determinant of reproductive success,but it is unclear whether the effect of sow backfat thickness on litter size is associated with endometrial receptivity and whether melatonin treatment may have benefits.The present study seeks to answer these questions through in vitro and in vivo investigations.Results Excessive lipid deposition and lower melatonin levels in the uterus are detrimental to endometrial receptivity and embryo implantation in high backfat thickness sows.In cells treated with melatonin,the MT2/PI3K/LIF axis played a role in reducing lipid accumulation in porcine endometrial epithelium cells and improved endometrial receptivity.Furthermore,we found a reduction of lipids in the uterus after eight weeks of intraperitoneal administration of melatonin to HFD mice.Notably,melatonin treatment caused a significant reduction in the deposition of endometrial collagen,an increase in the number of glands,and repair of the pinopode structure,ultimately improving endometrial receptivity,promoting embryo implantation,and increasing the number of litter size of mice.Conclusions Collectively,the finding reveals the harmful effects of high backfat thickness sows on embryo implantation and highlight the role of melatonin and the MT2/PI3K/LIF axis in improving endometrial receptivity by enhancing metabolism and reducing the levels of uterine lipids in obese animals.展开更多
Silicon Carbide (SiC) wafers have been widely used in micro- and nano-devices due to their excellent optical and material properties. However, polishing SiC wafers has been challenging and inefficient, tending to caus...Silicon Carbide (SiC) wafers have been widely used in micro- and nano-devices due to their excellent optical and material properties. However, polishing SiC wafers has been challenging and inefficient, tending to cause significant surface crack and subsurface damage. This work proposed modifying SiC surface properties by ion implantation to improve machining efficiency, suppress surface crack, and reduce damage. High-energy ion implantation disrupted the SiC crystal lattice, reducing hardness and elastic modulus while increasing brittle-ductile transition depth, thus changing the removal mode from brittle fracture to plastic removal. Theoretical models of material removal rate and surface roughness were established for abrasive polishing of the SiC wafers. Polishing experiments were conducted on ion-implanted, modified SiC samples. The improvement mechanisms of ion implantation on surface damage, removal rate, morphology, and residual stress were investigated. The effect of ion implantation on the polished surface quality of SiC was investigated through orthogonal experiments. The results showed that ion implantation can significantly improve the average material removal rate of the SiC samples. Additionally, the ion-implanted samples had exhibited remarkable reductions in surface roughness, surface damage, and tensile residual stress.展开更多
Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of t...Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])展开更多
Background:Recurrent implantation failure(RIF)is a difficult problem with a multifaceted cause.Recent studies have demonstrated that stimulator of interferon genes-induced immune-related genes(STIRGs)are associated wi...Background:Recurrent implantation failure(RIF)is a difficult problem with a multifaceted cause.Recent studies have demonstrated that stimulator of interferon genes-induced immune-related genes(STIRGs)are associated with immune disorders that may affect the endometrial immune micro-environment.However,the effect of STRIGs on RIF remains unknown.Methods:Training(GSE111974)and validation(GSE106602)cohorts were acquired from the Gene Expression Omnibus database.STIRGs were extracted from the Molecular Signatures Database and relevant studies.Consensus clustering analysis was used to identify RIF molecular subtypes.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment and immune infiltration analyses were performed between RIF subtypes.Drug-related potential therapeutic target genes were discovered.Results:Two distinct molecular subtypes were discovered in both the training and validation groups according to STIRGs.In subtype C2,there was a notable decrease in the presence of different types of immune cells,such as natural killer cells and macrophages.Furthermore,the examination of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated a decrease in numerous immune-related biological processes within subtype C2.Finally,nine hub genes(CXCR4,POU5F1,PPARG,TLR2,EGFR,CSF1,BCL2A1,BTK,and SRGN)were identified as potential therapeutic targets for RIF.Conclusion:Based on STIRGs,we identified a new molecular subtype with significantly reduced immune infiltration in RIF.Nine genes might be potential therapeutic targets for RIF.展开更多
BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psycholog...BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psychological and economic burdens for the patient and his/her family.AIM To investigate the psychological burden(anxiety and depression)and evaluate the clinical benefits of endometrial receptivity testing(ERT)in patients experiencing RIF following frozen-thawed ET.METHODS A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People’s Hospital of Changde City between January 2021 and June 2024.Demographic and clinical data were systematically collected through standardized questionnaires.Psychological assessment utilized validated instruments:The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment.Participants were stratified by psychological status(anxiety/non-anxiety and depression/nondepression)to analyze influencing factors for anxiety and depression.The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes.Additionally,they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models.Compared with the non-ERT group,the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate,thicker endometrium on transfer day,fewer embryos transferred,and a lower miscarriage rate.RESULTS The study identified a substantial psychological burden,with anxiety prevalence at 55.0%(mean Self-Rating Anxiety Scale score,50.89±9.34)and depression at 61.2%(mean Self-Rating Depression Scale score,55.55±9.48).Multivariate analysis identified annual household income>100000 yuan as protective factors against both anxiety and depression,whereas advanced maternal age(>35 years)and multiple implantation failures(≥3)served as risk factors.Additionally,anxiety-specific risk factors included prolonged infertility treatment(>5 years)and the spouse’s status as an only child.As to depression-specific risks,chronic infertility(>3 years)and higher educational attainment(college/bachelor’s degree or higher)were key determinants,whereas urban residence was a protective factor.Age>35 years was a risk factor for clinical pregnancy in patients experiencing RIF,whereas blastocyst-stage ET,a higher number of embryos transferred,and thicker endometrium were protective factors.CONCLUSION Patients experiencing RIF are particularly susceptible to anxiety and depression,and advanced maternal age and multiple implantation failures represent salient risk factors.Clinicians should implement proactive and evidencebased interventions to mitigate these psychological burdens.For patients experiencing RIF,ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.展开更多
To enhance the corrosion resistance and electrical conductivity, the surface of 316L stainless steel was modified by the ion implantation of Mo. By investigating various accelerating voltages and implantation doses, i...To enhance the corrosion resistance and electrical conductivity, the surface of 316L stainless steel was modified by the ion implantation of Mo. By investigating various accelerating voltages and implantation doses, it was found that the corrosion resistance of stainless steel was enhanced by 50%-80% and the surface conductivity by 15%-28% at most. The minimum stabilized current density is 0.72 μA/cm^(2). This is due to the formation of a Cr and Mo riched modified layer on the surface of the stainless steel. Mo oxides synergize with Cr oxides in the form of a solid solution to enhance the corrosion resistance of passivation films on the stainless steel surface. The optimum parameters were Cr in the proportion of 6%-8% and Mo in the proportion of 4%-5%.展开更多
PurposeThe study aimed to investigate the otology-specific and general health-related quality of life(HRQoL)after cochlear implantation,and scrutinize the variables associated with them.MethodsThe Ear Outcome Survey-1...PurposeThe study aimed to investigate the otology-specific and general health-related quality of life(HRQoL)after cochlear implantation,and scrutinize the variables associated with them.MethodsThe Ear Outcome Survey-16(EOS-16),which assesses ear-specific symptoms and quality of life(QoL),was administered before and after cochlear implantation along with the post-operative administration of the 15D questionnaire that evaluates general HRQoL.The authors investigated post-implantation changes in the EOS-16 total scores and its category responses,examining their relationship with pre-and post-operative hearing levels,speech perception in noise,and the follow-up period length(time elapsed since cochlear implantation).ResultsThere were positive changes noted for the hearing,need for care,and QoL categories of the EOS-16 after implantation.The length of the follow-up period was a significant factor associated with improvements in subjective outcome measures.Changes in self-perceived hearing and HRQoL post-implantation seem independent of pre-and post-implantation hearing performance.ConclusionThese results suggest that while patients regain their hearing abilities shortly after implant activation,their subjective hearing-related benefits and QoL improve over time.展开更多
Integrating the magneto-optical effect into a waveguide-based photonic device becomes more and more interesting.In the work,the planar optical waveguide firstly was prepared in a terbium gallium garnet crystal(TGG)via...Integrating the magneto-optical effect into a waveguide-based photonic device becomes more and more interesting.In the work,the planar optical waveguide firstly was prepared in a terbium gallium garnet crystal(TGG)via the proton implantation with the energy of 4×10^(-1)MeV and the fluence of 6×10^(8)ions/μm^(2).Subsequently,a femtosecond laser with a central wavelength of 800 nm and a power of 3 mW was used to ablate the surface of the planar waveguide,forming the ridge optical waveguide.The dark-mode curve of the planar waveguide was measured by a prism coupling technique.The top-view morphology of the ridge waveguide was observed via a Nikon microscope.The mode field distributions of the planar and ridge waveguides were obtained by an end-face coupling system,and the propagation losses of the two waveguides were measured to be 2.26 dB/cm and 2.58 dB/cm,respectively.The Verdet constants were measured to be-72.7°/T·cm for the TGG substrate and-60.7°/T·cm for the ridge waveguide.The TGG waveguides have a potential in the fabrication of magneto-optical waveguide devices.展开更多
AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)com...AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)combined with Ahmed glaucoma valve(AGV)implantation.METHODS:This is a retrospective,single-center,consecutive case series.All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection(IVR).The minimum postoperative follow-up period lasted 12mo.The primary outcome measures included bestcorrected visual acuity(BCVA),intraocular pressure(IOP),and topical hypotensive medications.RESULTS:Fifteen diabetic patients(age,46–81y)with rapid-onset NVG and VH following uncomplicated phacoemulsification were included.The median time to the initial NVG diagnosis following cataract surgery was within 4wk.After PPV combined with AGV implantation,the mean BCVA(logMAR)improved from 1.9(range:1.0 to 2.6)preoperatively to 1.2(range:0.2 to 2.6)at the final follow-up.Baseline BCVA and the presence of diabetic nephropathy(DN)were significantly associated with the final BCVA in the multiple regression model.The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline.At the final follow-up,9 patients required one or two topical ocular hypotensive medications,while the other 6 needed not.Success was achieved in 87%,and the reoperation rate was 20%.The majority of NVG cases(9/15)were primarily attributed to the rapid progression of proliferative diabetic retinopathy.However,a notable subset(6 eyes)was complicated retinal vein occlusion or carotid artery occlusion.CONCLUSION:PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments.Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.展开更多
BACKGROUND Phakic intraocular lens(IOL)implantation is a common treatment for high myopia.However,pre-and postoperative psychological changes,particularly anxiety and depression,are noteworthy concerns.Multiple studie...BACKGROUND Phakic intraocular lens(IOL)implantation is a common treatment for high myopia.However,pre-and postoperative psychological changes,particularly anxiety and depression,are noteworthy concerns.Multiple studies have indicated a close relationship between ophthalmic diseases,including high myopia,glaucoma,anxiety,and depression.AIM To evaluate the impact of phakic IOL implantation on anxiety and depression in patients with high myopia.METHODS Data from 136 patients with high myopia,who underwent phakic IOL implantation at the authors’hospital between June 2024 and December 2024,were retrospectively analyzed.Clinical data were collected from the hospital’s electronic medical records system.Preoperative and one-month postoperative data were compared.Anxiety,depression,sleep quality,and quality of life were evaluated using the Hamilton anxiety scale,Hamilton depression scale,Pittsburgh Sleep Quality Index,and 36-item Short Form Health Survey,respectively.RESULTS Of 136 patients,67.65%(n=92)were female and 32.35%(n=44)were male,with a mean±SD age of 28.02±5.72 years.The mean uncorrected visual acuity before and 1 month after treatment was 1.83±0.24 log minimum angle of resolution(MAR)and 0.03±0.07 log MAR,respectively.The mean best corrected visual acuity before and 1 month after treatment was 0.04±0.07 log MAR and 0.01±0.02 log MAR,respectively.All differences were statistically significant(P<0.05).Compared with pretreatment,Hamilton anxiety scale and Hamilton depression scale scores significantly decreased 1 month post-treatment(P<0.05).Furthermore,the Pittsburgh Sleep Quality Index score was significantly lower after than that before treatment(P<0.05).The 36-item Short Form Health Survey quality of life score significantly improved after treatment(P<0.05).CONCLUSION Phakic IOL implantation significantly reduces anxiety and depression and improves sleep quality and quality of life in patients with high myopia.This study provides new concepts for treating high myopia.展开更多
Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today.Among them,the implantable collamer lens(ICL)is favored for its wide range of correction,excellent optic...Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today.Among them,the implantable collamer lens(ICL)is favored for its wide range of correction,excellent optical quality,and high safety,but the risks of postoperative complications such as glaucoma and anterior subcapsular opacification still exist.Vault is an important indicator for evaluating the safety after ICL implantation,and its ideal state is crucial for preventing complications.Studies have shown that iris morphology has a significant impact on vault.In order to further optimize surgical outcomes and improve surgical safety,this review comprehensively reviews the research progress of iris-related parameters in ICL implantation and discusses the importance of various parameters in preoperative evaluation and postoperative follow-up.展开更多
AIM:To evaluate the accuracy of intraocular lens(IOL)power calculation formulas with/without preoperative aphakic anterior chamber depth(aph-ACD)in pediatric aphakia.METHODS:A total of 102 pediatric patients(150 eyes)...AIM:To evaluate the accuracy of intraocular lens(IOL)power calculation formulas with/without preoperative aphakic anterior chamber depth(aph-ACD)in pediatric aphakia.METHODS:A total of 102 pediatric patients(150 eyes)undergoing secondary IOL implantation were divided into two groups(in-the-bag or ciliary sulcus).Prediction error was calculated for 9 IOL power calculation formulas,including:1)not requiring ACD:Hoffer Q,Holladay 1,SRK/T;2)usable without or with entering ACD:Barrett Universal II(BUII),Emmetropia Verifying Optical(EVO)2.0,and Ladas Artificial Intelligence Super(Ladas AI);3)requiring ACD:Haigis,Kane,and Pearl-DGS.Mean prediction error(ME),mean absolute error(MAE),median absolute error(MedAE)and the percentage of eyes within±0.25,±0.50,±0.75,and±1.00 D were calculated.RESULTS:For the BUII,EVO 2.0,and Ladas AI,with aph-ACD demonstrated a higher MedAE compared to without aph-ACD(BUII:1.27 vs 1.13 D,EVO 2.0:1.26 vs 1.06 D,Ladas AI:1.30 vs 1.10 D;all P<0.05).Formulas requiring ACD(Haigis,Kane,and Pearl-DGS)exhibited larger MedAE than those not requiring aph-ACD(Hoffer Q,Holladay 1,and SRK/T;P<0.05).In the capsular group,the percentage of eyes within±1.00 D ranged from 44.83%to 74.14%,and it was 19.57%to 32.61%in the sulcus group.CONCLUSION:The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia,regardless of in-the-bag or sulcus IOL secondary implantation.The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.展开更多
Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of comp...Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.展开更多
AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 ...AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023.All patients underwent implantation of EVO-V4C ICLs.ICLs were selected based on STAAR’s recommended formula.Postoperative vault values were measured using anterior segment optical coherence tomography(ASOCT).First,feature selection was performed on patients’preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model.Subsequently,four regression models,namely MLP,XGBoost,RFR,and KNN,were employed to predict the vault,and their predictive performances were compared.The ICL size was set as the prediction target,with the vault and other input features serving as new inputs for predicting the ICL size.RESULTS:Among all preoperative parameters,16 parameters were most closely related to postoperative vault and were included in the prediction model.In vault prediction,XGBoost performed the best in the regression model(R^(2)=0.9999),followed by MLP(R^(2)=0.9987)and RFR(R^(2)=0.8982),while the KNN model had the lowest predictive performance(R^(2)=0.3852).XGBoost achieved a prediction accuracy of 99.8%,MLP had a prediction accuracy of 98.9%,while RFR and KNN had accuracies of 87.1%and 57.4%,respectively.CONCLUSION:AI effectively predicts postoperative vault and determines ICL size.XGBoost outperforms other machine-learning algorithms tested.Its accurate predictions help ophthalmologists choose the right ICL size,ensuring proper vaulting.展开更多
AIM:To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography(OCT)measurements of macular thickness(MT)and two parameters that define the struct...AIM:To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography(OCT)measurements of macular thickness(MT)and two parameters that define the structure of the optic nerve,the peripapillary nerve fiber layer(RNFL)and the Bruch’s membrane opening-minimum rim width(BMO-MRW).METHODS:This nonrandomized prospective pre-post study included 86 eyes of 48 patients(age,20-47y;axial length:23.10-28.95 mm)scheduled for myopia or myopic astigmatism correction with implantation of the implantable collamer lens(ICL).Eyes with glaucoma or any other ocular disease that could alter OCT results were excluded.RNFL,BMO-MRW and MT were measured preoperatively,and at 1 and 6mo after surgery using spectral-domain OCT.Changes between preoperative and postoperative values were evaluated.RESULTS:There was a significant increase in BMOMRW at 1mo(mean change:3.48±15.07μm,P=0.041).No significant changes were found during the rest of followup(1-6mo postop.,P=0.623).There was also a significant increase in RNFL thickness at 1mo af ter surger y(1.45±2.18μm,P<0.001),but with a significant reduction from 1 to 6mo postoperatively(P=0.002).Regarding MT,it increased significantly at 1mo(2.46±3.76μm,P<0.001),with a significant decrease afterwards(P=0.048).Measurements of the three parameters at 6mo were slightly superior to preoperative values(P<0.01).CONCLUSION:Minimal changes are induced in BMOMRW,RNFL and MT after ICL implantation in healthy eyes,confirming the safety of the surgical procedure regarding the structure of the optic nerve head and the macula,and indicating that this phakic intraocular lens seems to have a slight impact on OCT measurements.展开更多
Congenital heart disease(CHD)affects about 1%of live births.Among them,about 20%will undergo one or more surgical or percutaneous maneuvers on the right ventricle outflow tract or pulmonary valve.Transcatheter pulmona...Congenital heart disease(CHD)affects about 1%of live births.Among them,about 20%will undergo one or more surgical or percutaneous maneuvers on the right ventricle outflow tract or pulmonary valve.Transcatheter pulmonary valve implantation is a recently available less invasive alternative to surgery for treatment of right ventricular outflow tract dysfunction.Thus,residual dysfunction can be treated early and with a lower risk profile.This narrative review aimed to describe the state of the art of percutaneous pulmonary valve implantation.展开更多
文摘Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.
文摘Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.
文摘Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.
基金supported by National Natural Science Foundation of China(52271117)Educational Commission of Hunan Province of China(23A0107)High Technology Research and Development Program of Hunan Province of China(2022GK4038).
文摘To improve the corrosion resistance of biodegradable Mg alloys,WE43 alloys were implanted with Fe,Ti,Zn and Zr ions at the same implantation dose.The surface morphology,valence state of elements,nano-hardness(NH),elastic modulus(EM),degradation rate and in vitro cell experiments of the modified WE43 alloys were systematically studied.A modified layer composed of Mg,MgO,the implanted elements and their oxides was formed on the modified alloys.Since high-speed metal ions caused severe surface lattice damage,the surface hardness of the substrate considerable increased.Electrochemical tests demonstrated a substantial enhancement in the corrosion resistance of the modified alloys via the implantation of Ti and Zr ions,resulting in a reduction of the corrosion current density to 88.1±9.9 and 15.6±11.4μA cm^(−2),respectively,compared with the implantation of Fe and Zn ions.Biocompatibility tests showed that the implantation of Fe,Ti,Zn and Zr ions enhanced the anticoagulant and hemolytic resistance of the WE43 alloy.All surface-modified samples showed negligible cytotoxicity(0-1)at 12.5%extract concentration.Moreover,the alloys implanted with Fe,Ti and Zn ions significantly promoted proliferation of human umbilical vein endothelial cells(HUVEC)compared with the unmodified alloy.The results demonstrate that Ti ion implantation is the best choice for WE43 alloy modification to achieve outstanding corrosion resistance and biocompatibility.
基金supported by the China Agriculture Research System(CARS-35-PIG)the National Natural Science Foundation of China(32272847,U22A20516)+1 种基金the National Key Research and Development Program of China(No.2021YFF1000602)the Key Research and Development Program of Shaanxi Province(No.2022ZDLNY01–04)。
文摘Background Increased backfat thickness of sows in early gestation is negative to reproductive performance.Endometrial receptivity is an important determinant of reproductive success,but it is unclear whether the effect of sow backfat thickness on litter size is associated with endometrial receptivity and whether melatonin treatment may have benefits.The present study seeks to answer these questions through in vitro and in vivo investigations.Results Excessive lipid deposition and lower melatonin levels in the uterus are detrimental to endometrial receptivity and embryo implantation in high backfat thickness sows.In cells treated with melatonin,the MT2/PI3K/LIF axis played a role in reducing lipid accumulation in porcine endometrial epithelium cells and improved endometrial receptivity.Furthermore,we found a reduction of lipids in the uterus after eight weeks of intraperitoneal administration of melatonin to HFD mice.Notably,melatonin treatment caused a significant reduction in the deposition of endometrial collagen,an increase in the number of glands,and repair of the pinopode structure,ultimately improving endometrial receptivity,promoting embryo implantation,and increasing the number of litter size of mice.Conclusions Collectively,the finding reveals the harmful effects of high backfat thickness sows on embryo implantation and highlight the role of melatonin and the MT2/PI3K/LIF axis in improving endometrial receptivity by enhancing metabolism and reducing the levels of uterine lipids in obese animals.
基金support from the China Postdoctoral Science Foundation(No.2023M742735)the Postdoctoral Fellowship Program of CPSF,China(No.GZC20232029)+5 种基金the National Natural Science Foundation of China(No.52475530)the Shaanxi Postdoctoral Science Foundation,China(No.2023BSHEDZZ175)the Innovation Capability Support Program of Shaanxi Province,China(No.2021TD-23)the Key Industrial Chain Core Technology Research Project in Xi’an,China(No.23LLRH0029)the Natural Science Basic Research Program of Shaanxi,China(No.2024JC-YBQN-0490)the Fundamental Research Funds for the Central Universities,China(No.ZYTS24023).
文摘Silicon Carbide (SiC) wafers have been widely used in micro- and nano-devices due to their excellent optical and material properties. However, polishing SiC wafers has been challenging and inefficient, tending to cause significant surface crack and subsurface damage. This work proposed modifying SiC surface properties by ion implantation to improve machining efficiency, suppress surface crack, and reduce damage. High-energy ion implantation disrupted the SiC crystal lattice, reducing hardness and elastic modulus while increasing brittle-ductile transition depth, thus changing the removal mode from brittle fracture to plastic removal. Theoretical models of material removal rate and surface roughness were established for abrasive polishing of the SiC wafers. Polishing experiments were conducted on ion-implanted, modified SiC samples. The improvement mechanisms of ion implantation on surface damage, removal rate, morphology, and residual stress were investigated. The effect of ion implantation on the polished surface quality of SiC was investigated through orthogonal experiments. The results showed that ion implantation can significantly improve the average material removal rate of the SiC samples. Additionally, the ion-implanted samples had exhibited remarkable reductions in surface roughness, surface damage, and tensile residual stress.
文摘Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])
文摘Background:Recurrent implantation failure(RIF)is a difficult problem with a multifaceted cause.Recent studies have demonstrated that stimulator of interferon genes-induced immune-related genes(STIRGs)are associated with immune disorders that may affect the endometrial immune micro-environment.However,the effect of STRIGs on RIF remains unknown.Methods:Training(GSE111974)and validation(GSE106602)cohorts were acquired from the Gene Expression Omnibus database.STIRGs were extracted from the Molecular Signatures Database and relevant studies.Consensus clustering analysis was used to identify RIF molecular subtypes.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment and immune infiltration analyses were performed between RIF subtypes.Drug-related potential therapeutic target genes were discovered.Results:Two distinct molecular subtypes were discovered in both the training and validation groups according to STIRGs.In subtype C2,there was a notable decrease in the presence of different types of immune cells,such as natural killer cells and macrophages.Furthermore,the examination of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated a decrease in numerous immune-related biological processes within subtype C2.Finally,nine hub genes(CXCR4,POU5F1,PPARG,TLR2,EGFR,CSF1,BCL2A1,BTK,and SRGN)were identified as potential therapeutic targets for RIF.Conclusion:Based on STIRGs,we identified a new molecular subtype with significantly reduced immune infiltration in RIF.Nine genes might be potential therapeutic targets for RIF.
文摘BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psychological and economic burdens for the patient and his/her family.AIM To investigate the psychological burden(anxiety and depression)and evaluate the clinical benefits of endometrial receptivity testing(ERT)in patients experiencing RIF following frozen-thawed ET.METHODS A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People’s Hospital of Changde City between January 2021 and June 2024.Demographic and clinical data were systematically collected through standardized questionnaires.Psychological assessment utilized validated instruments:The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment.Participants were stratified by psychological status(anxiety/non-anxiety and depression/nondepression)to analyze influencing factors for anxiety and depression.The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes.Additionally,they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models.Compared with the non-ERT group,the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate,thicker endometrium on transfer day,fewer embryos transferred,and a lower miscarriage rate.RESULTS The study identified a substantial psychological burden,with anxiety prevalence at 55.0%(mean Self-Rating Anxiety Scale score,50.89±9.34)and depression at 61.2%(mean Self-Rating Depression Scale score,55.55±9.48).Multivariate analysis identified annual household income>100000 yuan as protective factors against both anxiety and depression,whereas advanced maternal age(>35 years)and multiple implantation failures(≥3)served as risk factors.Additionally,anxiety-specific risk factors included prolonged infertility treatment(>5 years)and the spouse’s status as an only child.As to depression-specific risks,chronic infertility(>3 years)and higher educational attainment(college/bachelor’s degree or higher)were key determinants,whereas urban residence was a protective factor.Age>35 years was a risk factor for clinical pregnancy in patients experiencing RIF,whereas blastocyst-stage ET,a higher number of embryos transferred,and thicker endometrium were protective factors.CONCLUSION Patients experiencing RIF are particularly susceptible to anxiety and depression,and advanced maternal age and multiple implantation failures represent salient risk factors.Clinicians should implement proactive and evidencebased interventions to mitigate these psychological burdens.For patients experiencing RIF,ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.
基金supported by the National Natural Science Foundation of China(22005140)Scientific Research Foundation for the Introduction of Talents by Nanjing Institute of Technology(YKJ201996)Postgraduate Research&Practice Innovation Program of Jiangsu Province(KYCX22_1370).
文摘To enhance the corrosion resistance and electrical conductivity, the surface of 316L stainless steel was modified by the ion implantation of Mo. By investigating various accelerating voltages and implantation doses, it was found that the corrosion resistance of stainless steel was enhanced by 50%-80% and the surface conductivity by 15%-28% at most. The minimum stabilized current density is 0.72 μA/cm^(2). This is due to the formation of a Cr and Mo riched modified layer on the surface of the stainless steel. Mo oxides synergize with Cr oxides in the form of a solid solution to enhance the corrosion resistance of passivation films on the stainless steel surface. The optimum parameters were Cr in the proportion of 6%-8% and Mo in the proportion of 4%-5%.
文摘PurposeThe study aimed to investigate the otology-specific and general health-related quality of life(HRQoL)after cochlear implantation,and scrutinize the variables associated with them.MethodsThe Ear Outcome Survey-16(EOS-16),which assesses ear-specific symptoms and quality of life(QoL),was administered before and after cochlear implantation along with the post-operative administration of the 15D questionnaire that evaluates general HRQoL.The authors investigated post-implantation changes in the EOS-16 total scores and its category responses,examining their relationship with pre-and post-operative hearing levels,speech perception in noise,and the follow-up period length(time elapsed since cochlear implantation).ResultsThere were positive changes noted for the hearing,need for care,and QoL categories of the EOS-16 after implantation.The length of the follow-up period was a significant factor associated with improvements in subjective outcome measures.Changes in self-perceived hearing and HRQoL post-implantation seem independent of pre-and post-implantation hearing performance.ConclusionThese results suggest that while patients regain their hearing abilities shortly after implant activation,their subjective hearing-related benefits and QoL improve over time.
基金supported by the Postgraduate Research and Innovation Program of Jiangsu Province,China(Grant No.KYCX241133)the National Natural Science Foundation of China(Grant No.11405041)+1 种基金the Key Research and Development Program of Jiangxi Province,China(Grant No.20223BBE51020)the Opening Fund of Key Laboratory of Rare Earths(Chinese Academy of Sciences).
文摘Integrating the magneto-optical effect into a waveguide-based photonic device becomes more and more interesting.In the work,the planar optical waveguide firstly was prepared in a terbium gallium garnet crystal(TGG)via the proton implantation with the energy of 4×10^(-1)MeV and the fluence of 6×10^(8)ions/μm^(2).Subsequently,a femtosecond laser with a central wavelength of 800 nm and a power of 3 mW was used to ablate the surface of the planar waveguide,forming the ridge optical waveguide.The dark-mode curve of the planar waveguide was measured by a prism coupling technique.The top-view morphology of the ridge waveguide was observed via a Nikon microscope.The mode field distributions of the planar and ridge waveguides were obtained by an end-face coupling system,and the propagation losses of the two waveguides were measured to be 2.26 dB/cm and 2.58 dB/cm,respectively.The Verdet constants were measured to be-72.7°/T·cm for the TGG substrate and-60.7°/T·cm for the ridge waveguide.The TGG waveguides have a potential in the fabrication of magneto-optical waveguide devices.
基金Supported by Shanghai Municipal Health Commission(No.202140183).
文摘AIM:To present a case series of rapid-onset neovascular glaucoma(NVG)accompanied by vitreous haemorrhage(VH)following cataract surgery in diabetic patients,and to evaluate the efficacy of pars plana vitrectomy(PPV)combined with Ahmed glaucoma valve(AGV)implantation.METHODS:This is a retrospective,single-center,consecutive case series.All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection(IVR).The minimum postoperative follow-up period lasted 12mo.The primary outcome measures included bestcorrected visual acuity(BCVA),intraocular pressure(IOP),and topical hypotensive medications.RESULTS:Fifteen diabetic patients(age,46–81y)with rapid-onset NVG and VH following uncomplicated phacoemulsification were included.The median time to the initial NVG diagnosis following cataract surgery was within 4wk.After PPV combined with AGV implantation,the mean BCVA(logMAR)improved from 1.9(range:1.0 to 2.6)preoperatively to 1.2(range:0.2 to 2.6)at the final follow-up.Baseline BCVA and the presence of diabetic nephropathy(DN)were significantly associated with the final BCVA in the multiple regression model.The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline.At the final follow-up,9 patients required one or two topical ocular hypotensive medications,while the other 6 needed not.Success was achieved in 87%,and the reoperation rate was 20%.The majority of NVG cases(9/15)were primarily attributed to the rapid progression of proliferative diabetic retinopathy.However,a notable subset(6 eyes)was complicated retinal vein occlusion or carotid artery occlusion.CONCLUSION:PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments.Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.
文摘BACKGROUND Phakic intraocular lens(IOL)implantation is a common treatment for high myopia.However,pre-and postoperative psychological changes,particularly anxiety and depression,are noteworthy concerns.Multiple studies have indicated a close relationship between ophthalmic diseases,including high myopia,glaucoma,anxiety,and depression.AIM To evaluate the impact of phakic IOL implantation on anxiety and depression in patients with high myopia.METHODS Data from 136 patients with high myopia,who underwent phakic IOL implantation at the authors’hospital between June 2024 and December 2024,were retrospectively analyzed.Clinical data were collected from the hospital’s electronic medical records system.Preoperative and one-month postoperative data were compared.Anxiety,depression,sleep quality,and quality of life were evaluated using the Hamilton anxiety scale,Hamilton depression scale,Pittsburgh Sleep Quality Index,and 36-item Short Form Health Survey,respectively.RESULTS Of 136 patients,67.65%(n=92)were female and 32.35%(n=44)were male,with a mean±SD age of 28.02±5.72 years.The mean uncorrected visual acuity before and 1 month after treatment was 1.83±0.24 log minimum angle of resolution(MAR)and 0.03±0.07 log MAR,respectively.The mean best corrected visual acuity before and 1 month after treatment was 0.04±0.07 log MAR and 0.01±0.02 log MAR,respectively.All differences were statistically significant(P<0.05).Compared with pretreatment,Hamilton anxiety scale and Hamilton depression scale scores significantly decreased 1 month post-treatment(P<0.05).Furthermore,the Pittsburgh Sleep Quality Index score was significantly lower after than that before treatment(P<0.05).The 36-item Short Form Health Survey quality of life score significantly improved after treatment(P<0.05).CONCLUSION Phakic IOL implantation significantly reduces anxiety and depression and improves sleep quality and quality of life in patients with high myopia.This study provides new concepts for treating high myopia.
基金Key Research and Development Projects of Zhejiang Science and Technology Plan(No.2021C03103)Research and Development Plan of Zhejiang Science and Technology Department(No.2023C03089)Scientific Research Project of Zhejiang Provincial Department of Education(No.Y202456401)。
文摘Phakic intraocular lens implantation has become one of the important means of correcting refractive errors today.Among them,the implantable collamer lens(ICL)is favored for its wide range of correction,excellent optical quality,and high safety,but the risks of postoperative complications such as glaucoma and anterior subcapsular opacification still exist.Vault is an important indicator for evaluating the safety after ICL implantation,and its ideal state is crucial for preventing complications.Studies have shown that iris morphology has a significant impact on vault.In order to further optimize surgical outcomes and improve surgical safety,this review comprehensively reviews the research progress of iris-related parameters in ICL implantation and discusses the importance of various parameters in preoperative evaluation and postoperative follow-up.
基金Supported by the Joint Funding Project of Municipal Schools(Colleges)of Science and Technology Program of Guangzhou,China(No.2023A03J0188)the Construction Project of High-Level Hospitals in Guangdong Province(No.303020102)the Natural Science Fund of Guangdong Province(No.2023A1515011102).
文摘AIM:To evaluate the accuracy of intraocular lens(IOL)power calculation formulas with/without preoperative aphakic anterior chamber depth(aph-ACD)in pediatric aphakia.METHODS:A total of 102 pediatric patients(150 eyes)undergoing secondary IOL implantation were divided into two groups(in-the-bag or ciliary sulcus).Prediction error was calculated for 9 IOL power calculation formulas,including:1)not requiring ACD:Hoffer Q,Holladay 1,SRK/T;2)usable without or with entering ACD:Barrett Universal II(BUII),Emmetropia Verifying Optical(EVO)2.0,and Ladas Artificial Intelligence Super(Ladas AI);3)requiring ACD:Haigis,Kane,and Pearl-DGS.Mean prediction error(ME),mean absolute error(MAE),median absolute error(MedAE)and the percentage of eyes within±0.25,±0.50,±0.75,and±1.00 D were calculated.RESULTS:For the BUII,EVO 2.0,and Ladas AI,with aph-ACD demonstrated a higher MedAE compared to without aph-ACD(BUII:1.27 vs 1.13 D,EVO 2.0:1.26 vs 1.06 D,Ladas AI:1.30 vs 1.10 D;all P<0.05).Formulas requiring ACD(Haigis,Kane,and Pearl-DGS)exhibited larger MedAE than those not requiring aph-ACD(Hoffer Q,Holladay 1,and SRK/T;P<0.05).In the capsular group,the percentage of eyes within±1.00 D ranged from 44.83%to 74.14%,and it was 19.57%to 32.61%in the sulcus group.CONCLUSION:The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia,regardless of in-the-bag or sulcus IOL secondary implantation.The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.
基金approved by the Institutional Review Board of Guangdong Provincial People's Hospital(KY-Q-2022-336-03).
文摘Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.
基金Supported by the National Natural Science Foundation of China(No.82271100)the Jiangsu Science and Technology Support Program(No.BE2022805)the Clinical Skills Enhancement Program of Jiangsu Province Hospital(No.JSPH-MC-2022-24).
文摘AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023.All patients underwent implantation of EVO-V4C ICLs.ICLs were selected based on STAAR’s recommended formula.Postoperative vault values were measured using anterior segment optical coherence tomography(ASOCT).First,feature selection was performed on patients’preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model.Subsequently,four regression models,namely MLP,XGBoost,RFR,and KNN,were employed to predict the vault,and their predictive performances were compared.The ICL size was set as the prediction target,with the vault and other input features serving as new inputs for predicting the ICL size.RESULTS:Among all preoperative parameters,16 parameters were most closely related to postoperative vault and were included in the prediction model.In vault prediction,XGBoost performed the best in the regression model(R^(2)=0.9999),followed by MLP(R^(2)=0.9987)and RFR(R^(2)=0.8982),while the KNN model had the lowest predictive performance(R^(2)=0.3852).XGBoost achieved a prediction accuracy of 99.8%,MLP had a prediction accuracy of 98.9%,while RFR and KNN had accuracies of 87.1%and 57.4%,respectively.CONCLUSION:AI effectively predicts postoperative vault and determines ICL size.XGBoost outperforms other machine-learning algorithms tested.Its accurate predictions help ophthalmologists choose the right ICL size,ensuring proper vaulting.
文摘AIM:To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography(OCT)measurements of macular thickness(MT)and two parameters that define the structure of the optic nerve,the peripapillary nerve fiber layer(RNFL)and the Bruch’s membrane opening-minimum rim width(BMO-MRW).METHODS:This nonrandomized prospective pre-post study included 86 eyes of 48 patients(age,20-47y;axial length:23.10-28.95 mm)scheduled for myopia or myopic astigmatism correction with implantation of the implantable collamer lens(ICL).Eyes with glaucoma or any other ocular disease that could alter OCT results were excluded.RNFL,BMO-MRW and MT were measured preoperatively,and at 1 and 6mo after surgery using spectral-domain OCT.Changes between preoperative and postoperative values were evaluated.RESULTS:There was a significant increase in BMOMRW at 1mo(mean change:3.48±15.07μm,P=0.041).No significant changes were found during the rest of followup(1-6mo postop.,P=0.623).There was also a significant increase in RNFL thickness at 1mo af ter surger y(1.45±2.18μm,P<0.001),but with a significant reduction from 1 to 6mo postoperatively(P=0.002).Regarding MT,it increased significantly at 1mo(2.46±3.76μm,P<0.001),with a significant decrease afterwards(P=0.048).Measurements of the three parameters at 6mo were slightly superior to preoperative values(P<0.01).CONCLUSION:Minimal changes are induced in BMOMRW,RNFL and MT after ICL implantation in healthy eyes,confirming the safety of the surgical procedure regarding the structure of the optic nerve head and the macula,and indicating that this phakic intraocular lens seems to have a slight impact on OCT measurements.
文摘Congenital heart disease(CHD)affects about 1%of live births.Among them,about 20%will undergo one or more surgical or percutaneous maneuvers on the right ventricle outflow tract or pulmonary valve.Transcatheter pulmonary valve implantation is a recently available less invasive alternative to surgery for treatment of right ventricular outflow tract dysfunction.Thus,residual dysfunction can be treated early and with a lower risk profile.This narrative review aimed to describe the state of the art of percutaneous pulmonary valve implantation.
