ObjectiveThis study aimed to investigate the protective effects of β-escin against neuroinflammatory injury and its influence on the interleukin-6/Janus kinase 2/signal transducer and activator of transcription 3 signaling pathway in a rat model of ischemic stroke.MethodsRats underwent a 2-h middle cerebral artery occlusion and were categorized into sham, middle cerebral artery occlusion, and middle cerebral artery occlusion treated with β-escin (0.45, 0.90, and 1.80 mg/kg) groups. Cerebral damage was assessed using 2,3,5-triphenyltetrazolium chloride and hematoxylin and eosin staining; neuronal apoptosis was evaluated via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay; serum levels of inflammatory cytokines (interleukin-6, tumor necrosis factor-α, and interleukin-1β) were measured using enzyme-linked immunosorbent assay, and protein expression of the interleukin-6/Janus kinase 2/signal transducer and activator of transcription 3 pathway was analyzed using western blot.Resultsβ-escin administration dose-dependently reduced Longa scores, cerebral infarction volume, and pathological damage while also attenuating neuronal apoptosis. It significantly suppressed the release of proinflammatory cytokines and downregulated the expression of interleuin-6 and interleukin-6 receptor as well as the ratios of phosphorylated Janus Kinase 2/Janus Kinase 2 and phosphorylated signal transducer and activator of transcription 3/ signal transducer and activator of transcription 3. These protective effects were positively correlated with the dosage of β-escin.ConclusionThe findings suggested that β-escin exerted neuroprotective effects in ischemic stroke by modulating the interleukin-6/Janus kinase 2/signal transducer and activator of transcription 3 pathway, thereby reducing neuroinflammation and apoptosis.

ObjectiveThe correlation between depression and prostatitis is widely acknowledged; however, there is a dearth of comprehensive risk models that can predict the risk of depression in patients with chronic prostatitis/chronic pelvic pain syndrome. In this investigation, we devised a predictive model to ascertain the likelihood of depression in these patients.MethodsThis prospective study enrolled 599 patients with chronic prostatitis/chronic pelvic pain syndrome between January 2022 and January 2025. The patients were randomly divided into training (70%, n = 419) and validation (30%, n = 180) cohorts. Using depression (Patient Health Questionnaire-9 score ≥10) as the primary outcome, we developed a nomogram using Boruta and least absolute shrinkage and selection operator feature selection followed by multivariate logistic regression. Model performance was assessed using receiver operating characteristic curve analysis (area under the receiver operating characteristic curve), calibration plots, and decision curve analysis, with internal validation performed in the validation cohort.ResultsThe nomogram integrated seven readily available predictors (prostate progression, hypertension, International Prostate Symptom Score, number of nights with sleep disturbance, white blood cell count, triglyceride level, and hemoglobin level) and showed excellent performance (area under the receiver operating characteristic curve values = 0.864 in the training cohort and 0.911 in the validation cohort).DiscussionThis nomogram can help urologists quickly identify chronic prostatitis/chronic pelvic pain syndrome patients at high risk of depression, enable early psychological intervention, and improve the quality of life of these patients.

Although labor epidural analgesia can effectively alleviate pain during childbirth, some women may experience a decrease in the effectiveness of the initially effective epidural analgesia or a complete loss of effectiveness (disappearance of the epidural block level) during labor. For cases where the analgesic effect is insufficient after the administration of additional medication or where the epidural block level is completely lost, it is recommended to replace the epidural catheter. When reinserting the epidural catheter, combined spinal-epidural anesthesia should be considered for labor analgesia, as this combination can shorten the onset time and reduce the failure rate. However, for some women who had received epidural analgesia for a long time, due to the expansion of the epidural space caused by local anesthetics, spinal anesthesia may be challenging. Therefore, we propose the use of an extended spinal needle among these patients as a modification of the standard practice to facilitate successful spinal anesthesia.

BackgroundAlthough hemorrhoidal disease is common worldwide, real-world evidence on the effectiveness of conservative treatments during the acute phase remains limited.ObjectiveWe aimed to assess the effectiveness of conservative treatment in improving symptoms and quality of life in patients with acute hemorrhoids in Vietnam.Patients and methodsThis was a prospective, international, observational, longitudinal study based on a subanalysis of the aCute HemORrhoidal disease evALuation International Study conducted from January 2022 to June 2022 at five major hospitals in Vietnam. The present study included adult patients (≥18 years) diagnosed with acute hemorrhoidal disease (≤48 h since onset) who received conservative treatment and did not require surgical intervention.ResultsAmong the 202 patients, 53% were male; the mean population age was 40.5 ± 13.7 years, and the mean body mass index was 22.13 ± 2.59 kg/m. The distribution of hemorrhoid severity was as follows: grade I, 22.3%; grade II, 59.9%; grade III, 12.4%; and grade IV, 5.4%. The mean number of symptoms per patient decreased from 4.6 ± 1.9 at baseline to 1.0 ± 1.5 at week four. At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding. The Hemorrhoid and Fissure Quality of Life significantly decreased across all domains ( < 0.05). Patient and physician satisfaction with conservative treatment was high, at 88.7% and 87.7%, respectively.ConclusionConservative treatment, particularly micronized purified flavonoid fraction-based therapy, improved the clinical symptoms and quality of life in patients with acute hemorrhoids in Vietnam.

BackgroundCystitis glandularis is a metaplastic lesion of the bladder mucosa. The underlying pathogenesis of cystitis glandularis and the potential association between the therapeutic effects of pachymic acid and ferroptosis remain unclear.MethodsHuman bladder epithelial cells (SV40-immortalized human urothelial cells-1 (SV-HUC-1)) and Sprague-Dawley rat bladders were treated with lipopolysaccharide, with pachymic acid and ferrostatin-1 used as interventions. Cell viability was determined using the Cell Counting Kit-8 (CCK-8) assay. Levels of reactive oxygen species, glutathione, and malondialdehyde were quantified in both cells and tissues. Levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in rat bladder tissues were quantified using enzyme-linked immunosorbent assay kits. The expression levels of nuclear factor erythroid 2-related factor 2, glutathione peroxidase 4, and solute carrier family 7 member 11 were analyzed, and bladder inflammation was evaluated using hematoxylin and eosin staining. The mitochondrial ultrastructure of bladder tissue was examined using transmission electron microscopy.ResultsLipopolysaccharide treatment reduced cell viability, increased malondialdehyde and reactive oxygen species levels, and decreased glutathione levels in both cells and tissues. The levels of nuclear factor erythroid 2 related factor 2, glutathione peroxidase 4, and solute carrier family 7 member 11 were reduced, while those of inflammation markers were elevated. Lipopolysaccharide stimulation induced mitochondrial structural damage in rat bladder tissues. Treatment with pachymic acid and ferrostatin-1 partially reversed these effects.ConclusionsFerroptosis plays a critical role in lipopolysaccharide-induced cystitis glandularis. Pachymic acid may alleviate cystitis glandularis by inhibiting ferroptosis, offering a novel therapeutic strategy for the clinical management of this disease.

ObjectiveMammography and ultrasound are commonly used for early detection of breast cancer; however, they have several limitations and are outperformed by magnetic resonance imaging for screening and diagnosis because of its higher sensitivity. This study aimed to evaluate female awareness of magnetic resonance imaging as a tool for early breast cancer detection and to enhance early-stage diagnosis.MethodsA cross-sectional study was conducted using an online questionnaire. Data were analysed using Statistical Package for the Social Sciences software. Awareness was categorised as poor or good.ResultsA total of 498 women participated in this study. Although 98% of the participants recognised the importance of early breast cancer detection, only 42.6% were aware of the role of breast magnetic resonance imaging. Awareness of the ability of magnetic resonance imaging to detect intraductal carcinoma and small invasive tumours, particularly in dense breast tissue, was moderate, with a mean awareness score of 2.5 ± 1.1 out of 4. Awareness was significantly higher among older women, those with family history of breast cancer and those who practised self-examinations or had prior magnetic resonance experience (p ≤ 0.002).ConclusionsThis study highlights a deficiency in awareness regarding the value of magnetic resonance imaging in breast cancer screening, particularly among young women with dense breast tissue and those without prior exposure to magnetic resonance imaging.

BackgroundsThe Systemic Inflammatory Index, a comprehensive marker of blood inflammation linked to multiple diseases, was examined for its association with adult asthma in this large-scale study.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (2009-2020) to explore the relationship between adult asthma (defined by self-report/medication use) and the Systemic Inflammatory Index score (calculated using blood cell counts). We employed weighted logistic regression analysis and restricted cubic splines to examine associations and nonlinear relationships. Subgroup analyses were conducted to evaluate potential interactions among subgroups stratified by sex, age, race, educational level, poverty-income ratio, smoking status, and alcohol consumption.ResultsThere were 23,176 participants in this study; of these, 3840 (15.02%) had asthma. Logistic regression analysis showed that high Systemic Inflammatory Index (log-transformed) scores were associated with increased asthma prevalence. Subgroup analysis revealed that there is no significant interaction effects in the association between the two entities across subgroups ( for interaction >0.05). Restricted cubic spline plots showed a consistent upward trend in asthma prevalence with increasing Systemic Inflammatory Index scores.ConclusionsOverall, higher Systemic Inflammatory Index scores were associated with higher prevalence of adult asthma in this study. As a cost-effective and readily accessible composite inflammatory marker, the Systemic Inflammatory Index holds potential clinical value in the diagnosis and prevention of adult asthma.

PurposeThis review aimed to compare the efficacy of various sympathetic nerve regulation techniques in the treatment of cold sensations or abnormal sweating in hemiplegic limbs following stroke, providing guidance for managing autonomic nervous system dysfunction in post-stroke patients.MethodsA comprehensive search of the PubMed and China National Knowledge Infrastructure databases was conducted using the keywords "cerebral infarction," "cerebral hemorrhage," "stroke," "stellate ganglion block," "sympathetic nerve block," "sympathetic neurolysis," and "radiofrequency sympathectomy." Relevant studies published in English on the use of sympathetic nerve regulation to treat cold sensations or abnormal sweating in hemiplegic limbs after stroke were selected and rigorously reviewed. The collected literature was then categorized based on content and reviewed along with experimental results and clinical case evidence.ResultsSympathetic nerve regulation significantly improves cold sensation and abnormal sweating in hemiplegic limbs by inhibiting sympathetic activity, reducing sympathetic tone, increasing collateral and peripheral circulation, and enhancing skin and muscle blood perfusion, thereby increasing limb temperature and improving patient quality of life.ConclusionComputed tomography-guided thoracic/lumbar sympathetic radiofrequency ablation has demonstrated significant and lasting efficacy, with minimal complications. Therefore, it is recommended for treating cold sensations or abnormal sweating in hemiplegic limbs post-stroke.

ObjectiveWe aimed to compare positivity before and during the coronavirus disease 2019 pandemic.MethodsPatients who underwent a standardized skin surface biopsy and direct microscopic examination for species in the prepandemic or pandemic period at a tertiary care center were included. The positivity rates in the two periods were compared across age, sex, and months using a proportional Z-test. A  value <0.05 was considered statistically significant.ResultsIn total, 573 and 523 patients were included in the pandemic and prepandemic periods, respectively. positivity was significantly higher in the pandemic period (68.9%) than in the prepandemic period (50.5%)  < 0.00001). positivity increased significantly among male ( = 0.00386) and female groups  < 0.00001) in the pandemic period compared with that in the prepandemic period. Positivity rates increased in all age groups, with significant increases observed in those aged 10-25 ( = 0.00006), 36-45 ( = 0.0012), and 46-55 ( = 0.01242) years.Conclusion positivity was higher in the pandemic period than in the prepandemic period, with significant increases observed during colder months. Furthermore, the increase in positivity was most prominent in patients aged 10-25 years, who spend more time in schools or crowded work places. Therefore, a possible association of face mask use and higher positivity must be explored through future controlled studies.

ObjectiveThis study compared the pharmacokinetic/pharmacodynamic properties of extended infusion and continuous infusion of imipenem at equivalent daily doses in a real-world setting.MethodsIn this prospective observational study, physicians adjusted imipenem doses empirically based on renal function and infection severity. Plasma concentrations were quantified via liquid chromatography-mass spectrometry, and pharmacokinetic parameters were calculated. Pharmacokinetic/pharmacodynamic targets were defined as 100% of the dosing interval with free drug concentrations above the minimum inhibitory concentration (MIC) and four times above the MIC, with MICs set at 1, 2, 4, 8, and 16 mg/L.ResultsThe analysis included 20 patients with extended infusion (0.5 g q6h/q8h or 1 g q8h) and 20 with continuous infusion (matched doses). Continuous infusion showed lower trough concentration variability (coefficient of variation: 25.5% vs. 67.3%) and significantly higher area under the curve and minimum plasma concentration values at all doses ( ≤ 0.002). Continuous infusion achieved superior target attainment: for 100% T > MIC, significant differences were observed at MICs ≥4 mg/L (=0.01). For 100% T > 4× MIC, continuous infusion outperformed extended infusion starting from MICs ≥1 mg/L (<0.01), with 3.0 g/day continuous infusion achieving 100% attainment at an MIC of 4 mg/L.ConclusionsContinuous infusion demonstrated superior pharmacokinetic/pharmacodynamic target attainment than extended infusion at equivalent doses, particularly for pathogens with an MIC ≥4 mg/L or cases requiring aggressive targets. Continuous infusion may benefit patients with elevated creatinine clearance, those with infections caused by pathogens with high MIC, and those requiring aggressive pharmacodynamic target attainment.

Spontaneous uterine rupture outside of pregnancy is exceptionally rare, with adenomyosis potentially acting as a structurally weakening substrate. Most reports involve gravid patients, underscoring the unusual nature of nongravid presentations. We report the case of a 26-year-old nongravid, nulliparous woman who presented with sudden, diffuse abdominal pain and hemorrhagic shock. Imaging revealed a markedly enlarged, heterogeneous uterus with hemoperitoneum. Emergency laparotomy evacuated approximately 3000 mL of blood. Multiple transmural ruptures precluded repair, necessitating total hysterectomy with adnexal preservation. Histopathology confirmed diffuse adenomyosis with extensive hemorrhagic necrosis.This case highlights that in reproductive-age women presenting with an acute abdomen, a negative pregnancy test, and an enlarged heterogeneous uterus, spontaneous rupture secondary to adenomyosis should be considered. Early resuscitation and definitive surgical management are critical, and proactive counseling is recommended for patients with severe adenomyosis who may be at risk for catastrophic decompensation.

Shoulder pain after gynecological laparoscopic surgery is increasingly being regarded as a serious clinical problem. The main risk factors are excessively high CO pressure during pneumoperitoneum, a very rapid CO insufflation rate, and excessive residual CO under the diaphragm. The mechanisms underlying the development of shoulder pain include mechanical stimulation, chemical stimulation, and the relationship with the intraoperative body position. On the basis of these risk factors and mechanisms, preventive measures can be implemented from three perspectives: surgery, nursing, and medication. In terms of surgical interventions, prevention involves limiting the pneumoperitoneum pressure and CO insufflation rate and removing as much residual CO gas as possible at the end of the surgery. From the nursing viewpoint, diverse interventions are implemented from multiple perspectives throughout the perioperative period. Additionally, preventive measures involving medications are being studied. This article reviewed the clinical characteristics, mechanisms, risk factors, and preventive measures for shoulder pain after laparoscopic gynecological surgery, with the aim of providing a reference for effective prevention strategies.

ObjectiveThis retrospective cohort study aimed to investigate the independent risk factors for vertebral artery stenosis following radiotherapy for nasopharyngeal carcinoma and construct a nomogram-based prediction model to assess its clinical utility.MethodsIn total, 386 nasopharyngeal carcinoma patients who underwent radiotherapy at a tertiary hospital between 2017 and 2023 were included; the median follow-up duration was 23.3 (interquartile range, 12.5-33.7) months, and the incidence of vertebral artery stenosis was 29.8% (115/386). Univariate Cox regression analysis was used to identify factors associated with vertebral artery stenosis, followed by least absolute shrinkage and selection operator (LASSO) regression analyses to determine the key variables. Multivariate Cox regression was applied to identify independent risk factors, which were used to construct a nomogram prediction model. The model's accuracy and predictive performance were evaluated using calibration curves and receiver operating characteristic analysis.ResultsUnivariate Cox regression analysis identified 12 significant variables, among which 4 key factors were selected through LASSO regression analysis. Multivariate Cox regression analysis revealed that V60 (hazard ratio: 1.09, 95% confidence interval: 1.07-1.10,  < 0.001), hyperlipidemia (hazard ratio: 1.66, 95% confidence interval: 1.05-2.64,  = 0.030), and body mass index (hazard ratio: 1.19, 95% confidence interval: 1.15-1.22,  < 0.001) were independent risk factors for vertebral artery stenosis. The nomogram prediction model constructed using these factors demonstrated high predictive performance, with calibration curves indicating excellent agreement between predicted and observed outcomes. Receiver operating characteristic analysis showed that the areas under the curve for 1-, 2-, and 3-year predictions were 0.99, 0.99, and 0.98, respectively.ConclusionThe nomogram model based on multiple clinical parameters demonstrated good performance in predicting the risk of vertebral artery stenosis following radiotherapy for nasopharyngeal carcinoma in internal validation. It may serve as a useful tool for the early identification of high-risk patients and support prognosis management strategies.

BackgroundThe inherent brittleness of calcium phosphate cement has limited its clinical application. Polyvinyl alcohol fibers have been demonstrated to enhance the tensile toughness of concrete matrices. However, only a few international studies have investigated the modification of calcium phosphate cement using polyvinyl alcohol fibers. These studies have predominantly focused on the macroscopic and microscopic mechanical properties, often neglecting comprehensive evaluations of the composites' osteoconductivity, degradation rate, and osteogenic properties.ObjectiveTo evaluate the cellular biocompatibility, bending strength, elastic modulus, and fracture toughness of polyvinyl alcohol/calcium phosphate cement composites, as well as to assess their degradability and osteoconductivity, providing a theoretical basis for their potential clinical application.MethodPolyvinyl alcohol/calcium phosphate cement composite cement was prepared by incorporating polyvinyl alcohol fibers into the calcium phosphate cement solid phase. The degradability of the composite material was assessed via in vitro immersion experiments. Biocompatibility was evaluated by observing cell morphology and growth, using the cell counting kit-8 for assessing the cell viability and performing live/dead fluorescent staining. The impact of the composite on cellular alkaline phosphatase activity was determined using alkaline phosphatase assays. Finally, the composite material's bending strength, elastic modulus, and fracture toughness were measured through three-point bending tests. Incorporation of polyvinyl alcohol fibers significantly enhances the fracture toughness of calcium phosphate cement. Additionally, the bending strength and Young's modulus of the composite material are improved, addressing the high brittleness of calcium phosphate cement. The composite material maintains the excellent biocompatibility and osteoconductivity of the calcium phosphate cement. Furthermore, the osteogenesis and degradation rate of the composite do not significantly differ from those of calcium phosphate cement.

Mixed connective tissue disease is an autoimmune disorder characterized by the presence of various abnormal autoantibodies and systemic involvement. Similar to systemic lupus erythematosus, pulmonary manifestations commonly include interstitial fibrosis, pulmonary hypertension, and pleurisy; however, pulmonary thromboembolism has rarely been reported in mixed connective tissue disease. We report a case of mixed connective tissue disease in which pulmonary thromboembolism was the initial manifestation, as diagnosed by computed tomography angiography. Following glucocorticoid and anticoagulant therapy, the thrombus resolved completely. This case highlights that in patients with mixed connective tissue disease, particularly those presenting with dyspnea or sudden-onset dyspnea, the possibility of pulmonary thromboembolism should not be overlooked.

ObjectiveWe aimed to investigate the associations between beta-blocker use and survival outcomes, including cancer-specific mortality, all-cause mortality, median overall survival, and median progression-free survival, in patients with colorectal cancer. The findings are intended to inform evidence-based strategies for optimizing adjuvant therapy in clinical practice.MethodsWe conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library to identify studies assessing the effect of beta-blockers on survival outcomes in patients with colorectal cancer. Studies reporting hazard ratios and 95% confidence intervals for cancer-specific mortality, all-cause mortality, median overall survival, or median progression-free survival were included. Adjusted hazard ratios were pooled using meta-analytic techniques. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity and assess result robustness.ResultsOverall, 13 high-quality cohort studies including >93,000 patients with colorectal cancer were included. Beta-blocker use was marginally associated with reduced cancer-specific mortality (hazard ratio = 0.90; 95% confidence interval: 0.81-1.00), with a more pronounced effect among patients who had not undergone surgery (hazard ratio = 0.86; 95% confidence interval: 0.75-0.98). Although no overall association was observed for all-cause mortality (hazard ratio = 0.76), a significant reduction was noted in the subgroup that underwent curative surgery (hazard ratio = 0.65; 95% confidence interval: 0.42-1.00). Among patients receiving bevacizumab, beta-blocker use was linked to improved median overall survival (hazard ratio = 0.70; 95% confidence interval: 0.56-0.87), whereas a nonsignificant trend toward improved median progression-free survival was observed (hazard ratio = 0.79; 95% confidence interval: 0.60-1.05). Sensitivity analyses supported the robustness and consistency of the pooled results.ConclusionsThis meta-analysis indicates that beta-blocker use is significantly associated with a reduced risk of cancer-specific mortality in patients with colorectal cancer, with the most pronounced benefit observed among those who did not undergo surgery. Additionally, patients undergoing radical resection or bevacizumab-based therapy may also experience improved survival with beta-blocker use. Given the well-established cardiovascular safety, affordability, and broad clinical availability, beta-blockers may serve as promising adjuncts for comprehensive colorectal cancer treatment. However, further randomized controlled trials are warranted to validate these findings and define optimal patient populations, timing, and combination strategies. This study was registered with PROSPERO (CRD420251079257).

ObjectiveColorectal neuroendocrine tumors and polyps share similar endoscopic features, often resulting in misdiagnosis. As neuroendocrine tumors are rare, obtaining a sufficient number of images for deep learning models is challenging.MethodsThis study introduces a few-shot learning model for ternary classification of neuroendocrine tumors, serrated lesions and polyps, and traditional adenomas using endoscopic images. Three groups of images (56 serrated lesions and polyps, 86 adenomas, and 53 neuroendocrine tumors) were collected retrospectively and divided into Support Sets and Query Sets. The proposed few-shot learning model involved transfer learning using ResNet50 V2 pretrained on ImageNet and esophageal endoscopic images, followed by metric learning based on Euclidean distances and K-nearest neighbor classification.ResultsEvaluated across three rounds, the few-shot learning model outperformed conventional deep learning models and both junior and senior endoscopists in several metrics, achieving an average macro-area under the curve of 0.731, macro-F1-score of 0.674, Matthews correlation coefficient of 0.526, and Cohen's kappa of 0.523. When identifying neuroendocrine tumors specifically, the model achieved the highest accuracy (0.823), sensitivity (0.653), precision (0.673), and F1-score (0.659).ConclusionsThe few-shot learning approach effectively addresses data scarcity issues and improves diagnostic accuracy, offering a promising tool for computer-aided diagnosis of rare gastrointestinal diseases.

Pulmonary extranodal mucosa-associated lymphoid tissue lymphoma (MALToma) is a slow-growing lymphoma often misdiagnosed or undiagnosed due to its nonspecific clinical symptoms. A man in his late 30s initially presented with cough, sputum production, and chest pain, which improved after antibiotic treatment. A definitive diagnosis of pulmonary MALToma was established via bronchoscopic biopsy. Following the exclusion of alternative diagnoses through metagenomic next-generation sequencing of bronchoalveolar lavage fluid, the marked eosinophilia and diverse chest computed tomography findings highlight the need for clinical awareness of this disease.

ObjectiveTo evaluate the clinical efficacy of a novel ophthalmic viscosurgical device-free method using an anterior chamber maintainer for intraocular collamer lens implantation in eyes with myopia.MethodsForty patients underwent bilateral intraocular collamer lens implantation, with one eye receiving the traditional implantation method using an ophthalmic viscosurgical device and the other eye undergoing the anterior chamber maintainer method. Preoperative and postoperative parameters, including uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent, intraocular pressure, aberrations, subjective visual quality, corneal endothelial cell density, operation time, and complications, were compared between and within the two groups.ResultsIn the traditional group, 10% of eyes had intraocular pressure >22 mmHg at 2 h postoperatively, compared with 0% in the anterior chamber maintainer group ( < 0.001). The anterior chamber maintainer group showed better uncorrected and best-corrected distance visual acuity, spherical equivalent, total and low-order aberrations, and defocus at 1 day postoperatively (all  < 0.05), as well as shorter operation time (2.85 ± 0.30 vs. 4.37 ± 0.66 min,  < 0.001). No complications were observed except early intraocular pressure elevation in the traditional group.ConclusionThe anterior chamber maintainer intraocular collamer lens implantation method provides faster visual recovery, a shorter operation time, and more stable intraocular pressure. It offers a convenient alternative to the traditional approach, avoiding ophthalmic viscosurgical device-related complications without introducing new ones.

Spinal muscular atrophy is a severe neuromuscular disorder caused by mutations in the survival motor neuron 1 gene, leading to progressive motor neuron degeneration. Over the past decade, disease-modifying therapies targeting the survival motor neuron pathway-nusinersen, onasemnogene abeparvovec, and risdiplam-have significantly transformed the clinical landscape of spinal muscular atrophy. Despite their common therapeutic goal of restoring functional survival motor neuron protein levels, these agents differ markedly in their molecular design, route of administration, pharmacokinetic behavior, and population-specific efficacy. This narrative review provides a comprehensive synthesis of pre- and post-approval pharmacokinetic data from pivotal trials, real-world studies, and population-based modeling. Nusinersen, an intrathecal antisense oligonucleotide, demonstrates prolonged cerebrospinal fluid exposure and slow systemic clearance. Onasemnogene abeparvovec, a single-dose gene therapy, shows sustained survival motor neuron expression mediated by adeno-associated virus 9 vector delivery and episomal persistence in nondividing neurons. Risdiplam, an orally administered survival motor neuron 2 splicing modifier, exhibits systemic bioavailability with reliable central nervous system penetration and predictable pharmacokinetics across age groups. Elimination of gene products and oligonucleotides is a multifaceted process involving enzymatic degradation, immune responses, and excretion through the kidneys or liver. We further discussed how interindividual variability, age, survival motor neuron 2 copy number, and immunological factors influence pharmacokinetic-pharmacodynamic relationships. Personalized treatment strategies for spinal muscular atrophy are increasingly being guided by advances in pharmacokinetic modeling. As the field evolves, biomarker-based monitoring and combination therapies are emerging as promising complementary approaches. With growing clinical experience and an expanding body of pharmacokinetic research on targeted therapies, there is strong potential to further refine treatment strategies-ultimately making spinal muscular atrophy care more effective, safer, and more accessible for patients worldwide.