Background/Objectives: Estimate the prevalence of myopia among children aged 6-17 years in county and rural areas across seven geographically diverse provinces of China, and identify demographic, behavioral, and geographic factors associated with myopia, with particular focus on urban-rural and ethnic differences. Methods: A multi-stage stratified cluster sampling design was employed. Seven provinces were randomly selected, one from each of seven geographical regions of China (Southeast, North, Central, South, Southwest, Northwest, and Northeast). In each province, one rural county was randomly chosen. Within each county, one urban survey site (county town) and one rural survey site (village) were selected. From each site, one primary school and one junior high school were included. In each school, approximately 20 ± 2 students per grade (grades 1-9) were recruited. Uncorrected visual acuity and non-cycloplegic autorefraction were measured. Multivariable generalized linear mixed models (GLMM) with random intercepts at the class level were used to identify factors associated with myopia, accounting for the cluster sampling design. Results: The overall myopia prevalence was 42.9% (urban 49.6%, rural 36.0%). In the multivariable GLMM, educational stage was the strongest risk factor (grades 7-9 vs. 1-3: OR = 5.54). A significant district × ethnicity interaction was found only for Mongolian children: rural residence was strongly protective (OR = 0.19) compared to Han (OR = 0.65), and the ethnic advantage disappeared in county towns. Only 14.2% of myopic students had adequate correction. Conclusions: In conclusion, myopia is highly prevalent and severely under-corrected in rural China. Educational pressure is the main risk factor, and the rural protective effect is strongest in Mongolians but erodes with urbanization. Urgent public health actions, including vision screening, affordable spectacles, and lifestyle preservation, are needed to address this growing burden.

The management of methicillin-resistant Staphylococcus aureus (MRSA) keratitis remains highly challenging due to escalating antibiotic resistance and the severe, vision-threatening damage driven by uncontrolled inflammation. In this work, EGCG-Zn-VAN nanoparticles (NPs) were engineered as a multifunctional metal-phenolic network (MPN)-based platform to overcome these limitations through three integrated mechanisms: enhanced ocular retention, infection microenvironment-responsive antibiotic release, and synergistic anti-inflammatory activity. The carrier, formed by coordination-driven self-assembly of (-)-epigallocatechin gallate (EGCG) and Zn2+, enabled high vancomycin loading and provided prolonged precorneal residence. A checkerboard assay confirmed potent pharmacological synergy between the MPN matrix and vancomycin, while the platform exhibited robust pH-responsive behavior for preferential drug release under acidic infectious conditions. In a rat MRSA keratitis model, EGCG-Zn-VAN NPs combined potent bactericidal efficacy with effective modulation of the oxidative and inflammatory milieu. Notably, despite delivering a substantially lower antibiotic dose (∼14.9 μg/mL), the nanoparticle formulation significantly outperformed a clinical standard-of-care comparator (5% free vancomycin), achieving >95% reduction of MRSA burden and suppressing pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) toward near-baseline levels. Quantitative histomorphometry confirmed that treatment led to the preservation of corneal transparency, epithelial integrity, and physiological stromal thickness. These outcomes arise from the cooperative interplay between vancomycin and the ROS-scavenging EGCG-Zn network, establishing EGCG-Zn-VAN NPs as a versatile, stimuli-responsive nanotherapeutic platform capable of addressing both microbial burden and host pathology. This platform provides a promising dose-sparing strategy for the clinical management of drug-resistant bacterial keratitis and other inflammation-associated ocular infections.

Purpose:The aim of this study was to investigate ON/OFF pathway responses and the impact of contrast reduction in myopes and emmetropes. Design:This was a cross-sectional study. Subjects:Thirty-eight young adult participants aged 20 to 29 years were included. Their spherical equivalent refraction ranged from +0.75 to -5.75 diopters (D). Methods:All participants (20 myopes, 18 emmetropes) underwent multifocal electroretinogram recording after 90 minutes of exposure to monocular diffuse (contrast reduction) conditions. The 5 experimental conditions were assessed in random order on separate days for each participant: control (no diffuse), slight peripheral diffuse (0.8 Bangerter foil, 5 mm clear center), medium peripheral diffuse (MPD) (0.4 Bangerter foil, 9 mm clear center), MPD (0.4 Bangerter foil, 5 mm clear center), and medium full-field diffuse (0.4 Bangerter foil). Main Outcome Measures:P1- and P2-wave amplitudes, as well as the P2/P1 amplitude ratio at varying retinal eccentricities were analyzed. Results:Compared with those of emmetropic eyes, both P1- and P2-wave amplitudes were significantly lower in myopic eyes (P1-wave: 8.25 ± 1.42 vs 10.29 ± deg/deg2, P < 0.05; P2-wave: 2.52 ± 0.79 vs 3.89 ± 1.57 nV/de g2, P < 0.01). However, the decline in P2-wave amplitude (35%) was more pronounced than the reduction in P1-wave amplitude (20%), resulting in a decrease in the P2/P1 ratio (0.30 ± 0.07 vs 0.41 ± 0.19, P < 0.05). Compared with the control condition, all the peripheral diffuse conditions increased the P2-wave amplitude and significantly increased the P2/P1 ratio (0.38∼0.41 vs 0.30, all P < 0.05) in the entire analyzed field, whereas no change was observed in the full-field diffuse condition (P > 0.05). No significant differences between the slight and medium diffuse conditions were observed (P > 0.05). Conclusions:Peripheral contrast reduction significantly strengthened OFF-pathway responses, contributing to the restoration of ON/OFF pathway balance in myopic eyes. Financial Disclosures:The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

Outdoor exposure has been shown to help protect against myopia; however, low spatial frequency exposure alone cannot fully explain myopia risk. This study aimed to explore contrast polarity differences between indoor and natural environments. A total of 53,620 images from the Massachusetts Institute of Technology Indoor Scenes, Mapillary Vistas and Places365 databases were categorised as natural, urban or indoor (with further subdivisions). Local contrast polarity was quantified by calculating the proportions of positive-contrast (ON) and negative-contrast (OFF) pixels after Difference-of-Gaussians filtering at 0.5, 2 and 6 cycles per degree (cpd). Additionally, image features with a 0.4 Bangerter foil, highly aspherical lenslets lens and diffusion optics technology (DOT) lens were also evaluated. Natural environments exhibited high OFF proportions (0.555 at 0.5 cpd; 0.559 at 2 cpd and 0.555 at 6 cpd). Indoor environments had lower OFF dominance (0.536 at 0.5 cpd; 0.533 at 2 cpd and 0.531 at 6 cpd) across all frequencies (all p < 0.001). Among indoor subscenes, the OFF proportion was lowest in the nursery at 0.5 cpd (0.493), in the hospital room at 2 cpd (0.505) and in the bathroom at 6 cpd (0.508). Contrast-reducing optical interventions increased indoor OFF proportions at 0.5 cpd with scene-dependent magnitudes; however, this effect diminished at higher spatial frequencies. These findings underscore that built environments, particularly specific indoor subscenes, exhibit lower OFF proportions than natural environments. Enhancing low-frequency negative contrast indoors may guide myopia prevention and public health initiatives.

PurposeTo investigate the short-term effect of a longpass filter on myopic defocus-induced changes in axial length (AL) and choroidal thickness (ChT).MethodsThis study included 23 young myopic adults. AL and ChT were measured in both eyes before and after 60 min of +5 D myopic defocus induced in the right eye with either a longpass filter (>495 nm) or a neutral density (ND) filter of equal transmittance. The same ND filter was used for both the left eye and the control eye. The pupil diameter of the left eye was measured before and 10 min after each test session. Illumination was maintained at 100 lux.ResultsAfter 60 min of monocular defocusing with the ND filter, a significant reduction in AL (mean±SE) was observed in the right eye (−8.20 ± 3.01 μm; t = −2.72; p = 0.01). However, no significant change was noted in ChT (−0.73 ± 1.78 μm; t = −0.41; p = 0.69). With the longpass filter, no significant change in AL was observed (−1.11 ± 4.27 μm, t = −0.26, p = 0.80), but a significant reduction in ChT was observed (−4.56 ± 1.73 μm, t = −2.63, p = 0.02). Pupil size did not significantly differ between the two filters (F = 0.004, p = 0.95).ConclusionBlocking short wavelengths inhibited the acute axial shortening response to myopic defocus, suggesting a modulatory role of short wavelengths in refractive development under the present experimental conditions.

Background:In recent years, the global prevalence of myopia among children has continued to rise. The preschool years represent a critical period for visual development, and the widespread adoption of electronic screens among young children has brought increasing attention to pediatric visual health. However, the association between visual environmental exposures related to screen use-such as screen brightness and ambient illuminance-and the risk of myopia in preschool children has not been thoroughly investigated. Objective:This monitoring study aimed to investigate the association between electronic screen brightness, ambient illuminance, and axial length in preschool children to provide evidence-based support for developing screen brightness usage recommendations for this population. Methods:This cross-sectional monitoring study was conducted between March and July 2023 in Shanghai, China, involving 2 representative samples of kindergarten children aged 3 to 6 years. Each participant was provided with a tablet preinstalled with intelligent monitoring software, which continuously and objectively recorded real-time data on screen time and screen brightness over a consecutive 7-day period. In addition, comprehensive data collection encompassed standardized ophthalmic assessments, high-precision ambient illuminance measurements, simulated laboratory lighting evaluations, and parental questionnaires. Associations between ambient illuminance, screen brightness, and axial length were analyzed using multivariable linear regression and restricted cubic spline models. Results:Of the 199 children included in the total sample, 124 (62.3%) were boys, and 75 (37.7%) were girls. After adjustment for demographic characteristics, parental myopia, and screen use behaviors, the median ambient illuminance during tablet use was significantly inversely associated with axial length (β=-0.13, 95% CI -0.22 to -0.04; P=.006). A nonlinear dose-response relationship was identified between median screen brightness and axial length (Pnonlinearity=.004), with axial elongation accelerating beyond approximately 27 cd/m² and peaking around 56 cd/m². Boys (P<.001) and greater height (P=.33) were also significantly associated with longer axial length. Conclusions:Higher ambient illuminance during tablet use is associated with shorter axial length in preschoolers, whereas screen brightness exhibits a nonlinear effect on axial elongation. This study highlights the importance of optimizing both environmental lighting and device settings to protect visual health in young children, providing empirical support for guidelines on safe digital device use and ambient lighting conditions in early childhood.

AIM: To explore the repeatability, reproducibility, and agreement in the measurement of the choroidal vascularity index (CVI) for different swept-source optical coherence tomography (OCT) devices and between OCT and OCT angiography (OCTA) images. METHODS: Two swept-source OCT imaging systems, VG200I and Topcon DRI OCT Triton, were used to capture OCT and OCTA images in triplicate. The first and third images were taken by one operator, and the second image was taken by another operator. The built-in software was used to calculate the CVI from the OCTA images (CVI-OCTA), and a custom-designed algorithm was used to calculate the CVI from the OCT images (CVI-OCT). Repeatability and reproducibility were assessed with the intraclass correlation coefficient (ICC), and agreement between devices and between OCT and OCTA were evaluated with Bland-Altman analysis. RESULTS: Sixty-eight eyes from 35 adults (17 females) were included in the analysis. The average age of the participants was 23.6±2.3y, with an average spherical equivalent refraction of -3.08±2.47 D and an average AL of 25.21±1.20 mm. Both OCT devices demonstrated high repeatability and reproducibility in measuring the CVI-OCTA (all ICCs>0.894 across five choroidal regions) and CVI-OCT (all ICCs>0.838). Furthermore, the between-device agreement in measuring the CVI-OCT was good [mean difference (MD) ranging from -2.32% to -3.07%], but that in measuring the CVI-OCTA was poor (MD, 1.48% to -7.43%). Additionally, the between-imaging agreement (CVI-OCTA versus CVI-OCT) was poor for both devices (Triton, MD, 6.05% to 12.68%; VG200I, MD, 6.67% to 12.09%). CONCLUSION: Both OCT devices and the two analytical methods demonstrate good stability. The inter-device consistency of CVI-OCT is good, while the inter-device consistency of CVI-OCTA and the consistency between the two analytical methods in the same device are both poor.

Purpose:To compare the effects of vitrectomy combined with intraoperative anti-VEGF therapy versus intraoperative sectoral retinal photocoagulation on the anatomical and functional outcomes of branch retinal vein occlusion (BRVO) complicated by vitreous hemorrhage (VH). Design:Randomized, parallel-group clinical trial. Participants:The study included 34 patients diagnosed with BRVO complicated by VH. Methods:Patients were randomly assigned to receive either intraoperative intravitreal injection of 0.5 mg ranibizumab (anti-VEGF group) or sectoral retinal photocoagulation (laser group) after vitrectomy. Postoperative assessments included best-corrected visual acuity (BCVA), visual field, and fluorescent angiography. Main Outcome Measures:Mean deviation (MD) of the visual field at 12 months and intergroup differences. Results:The average MD of the visual field in the anti-VEGF group was significantly lower than that in the laser group (-8.5 ± 4.6 dB vs. -15.1 ± 3.5 dB, P < 0.01) at 12 months. The BCVA was 0.20 ± 0.29 logarithms of the minimum angle of resolution (logMAR) and 0.26 ± 0.20 logMAR in the anti-VEGF and laser groups, respectively (P = 0.53). Recurrence VH occurred in 2 cases (1 case showed no regression of retinal neovascularization and one case exhibited the occurrence of venous macroaneurysm) of the anti-VEGF group, which was less compared to the laser group, which had a total of 4 cases with recurrent VH (1 case showed no regression of retinal neovascularization, while 3 cases exhibited venous macroaneurysms). However, these differences were not statistically significant (P = 0.39). Postoperative development of collateral vessels (CVs) was more evident in the anti-VEGF group, whereas laser treatment disrupted CVs in several cases. Conclusions:Intraoperative anti-VEGF therapy is a safe and effective alternative to sector retinal laser photocoagulation for patients with BRVO complicated by VH undergoing vitrectomy. This approach offers the advantage of preserving the visual field and avoiding CV damage associated with laser treatment. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

This study evaluated the efficacy of spectacle lenses with highly aspherical lenslets (HALs) for myopia control in clinical practice. A retrospective cohort study with propensity score matching (PSM) was conducted using patients from the Eye Hospital, Wenzhou Medical University from July 1, 2020 to March 15, 2023. Participants wore either HALs or single-vision lenses (SVL). PSM was used to balance confounding factors between groups. Efficacy was assessed by comparing myopia progression (non-cycloplegic refractive error) and axial length (AL) elongation between the two groups. A total of 3419 HALs and 10,846 SVL users aged 3–18 years were included (mean SER: −2.92 ± 1.82 D, range +0.50 to −9.00 D). After PSM, 2050, 1524, 807 and 433 pairs were retained in the 0.5, 1, 1.5 and 2 year sub-datasets, respectively. Additionally, a sub-dataset containing AL measurement from 406 pairs at 1 year was analysed. In the matched dataset without AL, the HAL group exhibited significantly slower myopia progression both at 1 year (−0.33 vs. −0.63 D) and 2 years (−0.68 vs. −1.10 D) compared with the SVL group. Furthermore, in the 1-year matched dataset that included AL, the HAL group showed significantly less AL elongation (0.19 mm) and myopia progression (−0.37 D) than the SVL group (0.37 mm, 0.69 D). Subgroup analysis indicated that the reduction in myopia progression was evident amongst children aged 3–14 years with low and moderate myopia. However, no significant difference was observed in the 15–18 year-old subgroup with low-to-moderate myopia or in the high myopia subgroup (all p > 0.05). This real-world study found that wearing HALs effectively reduced myopia progression and axial elongation in children aged 3–14 years with low-to-moderate myopia. However, the efficacy of HALs was inconclusive in children aged 15–18 years and limited in those with high myopia.

AIMS:To investigate the changes in choroidal optical coherence tomography (OCT) radiomic features, their correlations with visual acuity and utility in identifying pathological myopia (PM). METHODS:A total of 288 myopic participants aged 18-50 years were included. Choroidal radiomic features were extracted and screened from OCT images via PyRadiomics and machine learning. Selected features were analysed for their associations with axial length, spherical equivalent, age and best corrected visual acuity (BCVA). Classification models were built using these features and their performance to identify PM was evaluated and compared with clinical parameters through five-fold cross-validation using metrics including area under the curve (AUC), accuracy, recall and F1 score. RESULTS:A total of 464 radiomic features were extracted and four choroidal intensity and shape features significantly correlated with axial length (p<0.001) were selected. Smaller maximum diameter, higher coarseness and greater perimeter surface ratio were significantly associated with worse BCVA (p<0.05). Radiomic features showed better performance than clinical features in both the internal test set (AUC=0.970 vs 0.938) and external validation set (AUC=0.858 vs 0.753) in identifying PM. Combining radiomic features with risk factors improved classification performance (AUC=0.990 internally and 0.892 externally). Among the included factors, intensity feature was most predictive for PM. CONCLUSIONS:OCT-based choroidal intensity and shape features were significantly correlated with axial elongation and visual impairment and outperformed clinical parameters in identifying PM. These features could serve as reliable biomarkers for monitoring high myopia progression.

Background Large-scale pediatric vision screening requires efficient and reliable methods for detecting significant refractive errors such as anisometropia, a leading cause of amblyopia. While cycloplegic autorefraction offers a rapid alternative to subjective refraction, its results lack an objective internal quality check. This study aimed to develop and validate a biometry-based formula for the rapid verification of sphere anisometropia in cycloplegic refraction. Methods This retrospective study included 3,730 children aged 3–18 years who underwent cycloplegic examination including ocular biometry, autorefraction, and subjective refraction. The cohort was temporally split into a Derivation Cohort (n = 2,487) and a Temporal Validation Cohort (n = 1,243). A multiple linear regression model was developed to predict sphere anisometropia from interocular differences in axial length and flat keratometry. Model performance was assessed using median absolute error and percentage of predictions within clinically relevant thresholds. Results The final formula, Anisometropia (D) = − 0.0438 + (− 2.4178 × ΔAxial Length) + (− 0.6525 × ΔFlat K), explained 89.7% of the variance (Adjusted R² = 0.8971). In the independent validation cohort, the median absolute prediction error was 0.45 D. Notably, 85.7% of predictions fell within ± 0.50 D and 99.2% within ± 1.00 D of the actual anisometropia value, indicating excellent clinical utility for screening purposes. Conclusions This biometry-based formula provides a rapid, objective, and practical tool for verifying sphere anisometropia in large-scale pediatric vision screening. By enabling immediate cross-verification of autorefraction results without additional calculations, it offers a feasible solution for embedding quality assurance into screening workflows. Trial Registration Retrospectively registered.

Persistent high-risk HPV (HR-HPV) infection is a major cause of cervical cancer. While vaccines exist, treatment options for those already infected are limited. This study aims to evaluate the effectiveness and immune response of combining human interferon α2b (hIFN) with modified Yihuang Decoction (YHD) for HR-HPV infection. This trial was conducted with 108 patients diagnosed with persistent HR-HPV infection. Participants received either hIFN monotherapy or a combination of hIFN and YHD (hIFN-YHD) for 3 months, followed by a 6-month follow-up. The primary outcomes included clinical efficacy, HR-HPV clearance rates, and changes in immune markers, such as IFN-γ, IL-4, and FPR3, in cervical biopsy tissues and vaginal lavage fluid. Treatment with hIFN-YHD resulted in significantly higher recovery (46.8

This study compared central visual quality in myopic children wearing spectacles with highly aspherical lenslets (HAL) versus traditional single-vision spectacle lenses (SV) and examined the association between contrast sensitivity and myopia control efficacy. Myopic children aged 8 to 15 years were enrolled. All participants had worn either HAL or SV spectacles for at least six months and were classified into HAL and SV groups. Central visual quality was assessed using the quick contrast sensitivity function (qCSF) with both HAL and SV test lenses in randomized order. Axial length was measured at the qCSF visit and again after six months. Seventy participants completed all examinations, with 31 in the SV group and 39 in the HAL group. A significant main effect of test lenses was found, with HAL test lenses yielding lower contrast sensitivity than SV test lenses (p = 0.002). A significant main effect of group was also observed (p = 0.01), with the HAL group showing lower contrast sensitivity than the SV group (mean difference: 0.10). This difference in central visual quality was consistent regardless of the test lens used (interaction effect p = 0.67). Contrast sensitivity was positively associated with axial elongation in the HAL group (p < 0.05) but not in the SV group. Satisfactory myopia control was defined as axial length progression of less than 0.055 mm over 6 months. A model with contrast sensitivity alone showed modest discriminative ability for myopia control (AUC = 0.63, p < 0.05). Adding covariates increased the AUC, but the improvement was not statistically significant (p = 0.08). In this exploratory subgroup analysis, lower post-wear contrast sensitivity was associated with slower axial elongation among HAL wearers, but prospective baseline validation is needed before clinical prediction can be established.

It is thought that polysaccharides cannot penetrate the intestinal mucosa into the circulatory system due to their high hydrophilicity and large molecular size. However, we show that different linked and charged polysaccharides can penetrate Caco-2 cell monolayers, and find β−1,3-linked glucan and α−1,4-linked glucan is detectable in rats (male) and mice plasma and liver after oral administration the isotope (99mTc, 3H) and fluorescein labeled polysaccharides. Using gene-knockdown strategies and inhibitors, we further show polysaccharide uptake requires clathrin heavy chain (CLTC) and its associated factors Rab5 and dynamin1 in intestinal cells. Strikingly, polysaccharide absorption is attenuated in both CLTC intestine deficient mice and RAB5A, DNM1conventional-knockout mice. Importantly, membrane receptors bone morphogenetic protein receptor type IA (BMPRIA), Dectin-1 and epidermal growth factor receptor (EGFR) are also critical for specific structural polysaccharide internalization. These findings provide novel insight to understand polysaccharide absorption mechanism and lay foundation for oral polysaccharide-based new drugs development. The study demonstrated that some exogenous natural polysaccharides could be absorbed in plasma with little degradation after orally administration. Polysaccharide uptake in the intestinal cells relied on clathrin/dynamin 1/Rab5-dependent endocytosis.

This study investigated the virulence factors and two-component systems (TCS) expression in carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-susceptible Klebsiella pneumoniae (CSKP). A total of 150 CRKP and 87 CSKP clinical isolates were collected from a tertiary hospital. Virulence genes, capsular serotypes, and hypermucoviscosity phenotype were detected. Serum resistance was assessed using serum killing assays, and virulence was preliminarily evaluated using the Galleria mellonella larvae lethality assays as a supplement. TCS gene expression (phoQ, rstA, rcsB, and ompR) was analyzed by qRT-PCR. The prevalence of hypervirulent K. pneumoniae (hvKP, defined by the key virulence gene cluster rmpA/rmpA2 + iucA + iroB + peg-344) was significantly lower in CRKP (carbapenem-resistant and hvKP [CR-hvKP], 5.3%) than in CSKP (CS-hvKP, 24.1%; P < 0.05). CRKP exhibited lower carriage rates of rmpA, iroB, peg-344, aerobactin, alls, and kfu, but higher rates of rmpA2 and ybtS compared to CSKP. CRKP was more likely to carry incomplete combinations of the key virulence genes than CSKP, with rmpA/rmpA2 + iucA being the most common. In CSKP, significant positive correlations were observed among virulence genes, but not in CRKP. In Galleria mellonella assays, hvKP and CR-hvKP showed significantly lower survival rates than classical K. pneumoniae and non-CR-hvKP (P < 0.05). TCS genes (phoQ, rstA, and ompR) were significantly upregulated in hvKP and CR-hvKP (P < 0.05). CRKP exhibited reduced virulence gene carriage compared to CSKP, likely due to the loss of virulence genes during plasmid transmission. However, the high prevalence of the key virulence genes in CRKP underscores the potential for CR-hvKP dissemination, necessitating continued surveillance to prevent its spread. The upregulation of phoQ, rstA, and ompR in hvKP is associated with the hypervirulent phenotype, providing correlative clinical evidence that links the expression of these functionally established TCS to hypervirulence in clinical isolates.IMPORTANCECarbapenem-resistant and hypervirulent Klebsiella pneumoniae (CR-hvKP) presents a serious clinical threat by combining antibiotic resistance and hypervirulence. This study reveals critical differences in the virulence gene and phenotype between carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-susceptible K. pneumoniae (CSKP). CRKP has a higher carriage rate of some key virulence genes than CSKP, suggesting region-specific evolutionary adaptations. Although CR-hvKP prevalence was lower than that of CS-hvKP, the persistent detection of key virulence genes in CRKP indicates ongoing dissemination risk, necessitating vigilant surveillance. Furthermore, the concurrent upregulation of two-component system genes (phoQ, rstA, and ompR) in hypervirulent clinical isolates represents a phenotypic signature worthy of further mechanistic exploration.

Endoscopic surgery demands continuous real-time visual decision-making under severe constraints, including a limited field of view, motion blur, and dynamically deforming anatomy. These factors impose substantial cognitive load on surgeons and motivate the integration of artificial intelligence (AI) throughout the endoscopic surgical workflow. This survey reviews recent progress in AI for endoscopic surgery and organizes the literature into four stages that span perception to action: (1) image enhancement and analysis methods that improve visual perception; (2) multimodal video understanding approaches that model and reason surgical instruments and anatomical structures over space and time; (3) 3D reconstruction techniques that enable robust tracking and interpretation of deformable anatomy; and (4) emerging paradigms of embodied surgical intelligence, where action-conditioned world models link perception to intraoperative assistance. Across these stages, we summarize current capabilities and limitations and identify key open challenges for clinical deployment. In addition, we provide an overview of 18 publicly available datasets, highlighting their scope and annotations. We hope this survey will stimulate further research toward reliable and clinically deployable AI systems for endoscopic surgery.

To evaluate accommodation-induced changes in the ciliary muscle (CM), Schlemm’s canal (SC), and trabecular meshwork (TM) in eyes with and without high myopia, and to assess the associations among these structures during accommodation. 116 eyes from 57 healthy control (HC) and 59 high myopia (HM) were assessed across two experiments. In the first experiment, pilocarpine-induced accommodation was applied to 78 eyes, while in the second, a -5 diopter (D) accommodative stimulus was used on 38 eyes. Anterior segment images were captured via swept-source optical coherence tomography before and after each accommodation stimulus. Measurements included the maximum thickness of CM and the anterior length of CM, the length of TM, and the area of SC. Statistical analyses evaluated group differences and correlations. Drug-induced and − 5D stimulation increased the maximum thickness of CM and the area of SC’s levels while decreasing the anterior length of CM’s levels. In the HC group, the length of TM was larger in the accommodative state, mediating the relationship between changes in the maximum thickness of CM and the area of SC. Conversely, these changes and correlations in the length of TM were insignificant in HM eyes. The length of TM increased with axial length and elongation in the anterior length of CM across all subjects; however, accommodation-related changes diminished as axial length (AL) and the anterior length of CM increased. Causal mediation analysis demonstrated that the anterior length of CM mediated the relationship between AL and the length of TM elongation. In two trials, accommodation-induced changes in the CM, TM, and SC were observed in eyes with or without HM, with reduced TM and SC response in HM. Differences in CM, TM, and SC behavior during accommodation between the HC and HM groups suggest that CM contraction may reshape the aqueous humor outflow channels. 1. In normal eyes, ciliary muscle contraction enlarges Schlemm’s canal via trabecular meshwork elongation. 2. Ciliary contraction fails to deform trabecular meshwork and Schlemm’s canal in high myopia. 3. Axial elongation stretches ciliary muscle but limits its ability to lengthen trabecular meshwork.

The development of novel antimicrobial materials that combine high bactericidal efficacy, precise targeting, excellent biocompatibility, and tissue repair capabilities has emerged as a frontier and urgent demand in the field of biomedical engineering. This systematic review focuses on antimicrobial material systems constructed through the combination of metal-organic frameworks (MOFs) and hyaluronic acid (HA). It elaborates on four major design strategies: physical modification, chemical coupling, multifunctional composites, and dosage form optimization. The core functional mechanisms include targeted enrichment, pH/enzyme/photothermal trigger response, metal ion dominance, antimicrobial agent-ROS synergy, and multi-mechanism coordination. Furthermore, the extensive applications of these composites in infection wound repair, treatment of specific site infections (mucosal, ocular, and pulmonary), and antimicrobial modification of medical materials (wound dressings, tissue engineering scaffolds, medical devices) are full analyzed. Future research should focus on developing intelligent responsive multi-target synergistic systems, advancing standardized preparation and preclinical evaluation system establishment, to accelerate the translation of MOF-HA antibacterial composites from laboratory research to clinical applications, providing innovative material solutions for addressing the global antimicrobial resistance crisis.

Intravitreal injection (IVT) of anti-vascular endothelial growth factor (VEGF) protein drugs is the gold-standard treatment for retinal vascular diseases, which affect over 100 million people globally. However, this invasive approach is associated with significant risks, including infection, optic nerve damage, etc. As a non-invasive alternative, eye drops provide a more patient-friendly delivery option, but the delivery of protein drugs to the retina is hindered by both dynamic and static biological barriers, as well as the high molecular weight and hydrophilic nature of the proteins. In this study, we introduce a peptide (CG2R9)-protein (bevacizumab, Beva)-zinc ions (Zn2+) co-assembly strategy to develop progressively smaller nanoparticles, (CG2R9&Beva)@Zn. We examine the factors influencing particle formation, size evolution, encapsulation efficiency, loading capacity, and protein biological activity. Our findings show that (CG2R9&Beva)@Zn nanoparticles significantly enhance ocular surface retention time (dynamic barrier) and effectively cross multiple ocular static barriers as their size decreases, facilitating efficient protein drug delivery to the retina. In an oxygen-induced retinal neovascularization model, these nanoparticles demonstrate appreciable therapeutic efficacy, without any observed biosafety concerns in 30 days of administration. This work presents a novel, non-invasive strategy for protein drug delivery, offering potential for the treatment of retinal diseases.