目的:通过计算机体层扫描(computed tomography,CT)平扫和三维重建等利用图像后处理系统软件,评估视网膜母细胞瘤(Retinoblastoma,RB)病灶的钙化水平,并探究其与患者性别、眼别、年龄及影像学分期之间的相关性。方法:选取2022年5月—2024年12月经我院眼眶病与眼肿瘤科手术病理证实及临床确诊的108例RB患者127眼进行分析。应用CT重建和工作站分割技术对眼球、肿瘤、钙化进行分割和采用容积定量分析方法,运用R语言进行统计学处理,比较不同性别(男/女)、眼别(左/右)、年龄分层及影像学分期间的钙化最高CT值、肿瘤钙化容积(calcified regional volume,CRV)、肿瘤容积(tumor volume,TV)、患侧容积(eyeball volume,EV)、CRV/EV、TV/EV、CRV/TV比值的差异。结果:不同性别组其EV比较差异有统计学意义(P<0.05);不同年龄组RB其CRV、EV、CRV/EV比较差异有统计学意义(P<0.05);影像分期(眼内期、青光眼期、眼外期组)和晶状体位置变化(位置改变、形态位置密度改变、无变化组)的CRV 、TV、CRV/EV、TV/EV差异均有统计学意义(P< 0.05)。结论:RB患者的钙化沉积水平随着病程推进,在眼球内期、青光眼期至眼外期的不同阶段呈现逐级升高的态势。晶状体位置变化随病情进展、RB患者钙化程度逐渐增加。
Objective: To evaluate the calcification level of retinoblastoma (RB) lesions using image post-processing system software, such as that for computed tomography (CT) noncontrast scanning and three-dimensional reconstruction. Additionally, this study aimed to explore the relationship between retinoblastoma (RB) and patient gender (male/female) , as well as the correlation among ocular (left/right), age, and radiographic stage (e.g., international intraocular RB stage). Methods: The study enrolled 108 patients (127 eyes) with tumors confirmed by both surgical pathology and clinical diagnosis. These patients received treatment at the Orbital Disease and Ocular Oncology Department of Zhongshan Ophthalmic Center, Sun Yat-sen University (ZOC, SYSU) from May 2022 to December 2024. CT reconstruction and workstation segmentation techniques were used to delineate the eyeball, tumour, and calcification. A quantitative volumetric analysis method was applied, and statistical processing was conducted using R language (version 4.2.1). Comparisions were made across different genders (male/female), eye segmentation (left/right), age stratifications, and imaging stages. The t-test was applied to analyze the highest CT value, calcified regional volume (CRV), tumor volume (TV), eyeball volume (EV), CRV/EV ratio, TV/EV ratio, and CRV/TV ratio in these tumor patients. Results: There was no significant differences in CT value, CRV, TV, CRV/EV ratio, TV/EV ratio, and CRV/TV ratio among patients with different eye sides, genders and age groups (P>0.05). Only EV showed statistical significant across different age groups. Statistically significant changes were observed in CRV, TV, CRV/EV ratio, TV/EV ratio , and CRV/TV ratio with respect to both intraocular stage (including intraocular stage, glaucoma stage, extraocular stage) and lens position changes (inculding position changes, morphological position density changes, no change groups) (P< 0.05), No other statistically significant differences were found (P>0.05). Conclusions: In this group of tumor patients, the level of calcification deposition gradually increased as the disease progressed through the intraocular stage, glaucoma stage, and extraocular stage. Lens positional changes were associated with a gradual increase in the degree of calcification in patients with retinoblastoma (RB) as the disease advanced.
目的:探讨环保试剂在眼科组织病理技术中的应用。方法:选取中山眼科中心2023年6月—2024年3月送检病理科手术标本190 例,一式两份分别采用环保试剂和传统试剂固定、脱水、透明、浸蜡、染色和封片,对两组试剂制片和染色的组织切片进行评价和判读、比较。结果:环保试剂组脱水、染色处理组织与传统试剂组相比,脱水效果良好,切片软硬适中,切面完整、无裂隙;苏木精-伊红(hematoxylineosin, HE)染色镜下可见细胞核结构清晰、核质对比鲜明、背景干净,两组优良片率分别为97.9%、98.4%,各级片差异无统计学意义(Z = –0.645,P=0.519);免疫组织化学染色的组织抗原性完好,阳性信号强、定位准确,无背景染色。结论:应用环保试剂替代传统试剂在眼科组织标本中脱水、染色应用效果良好,可满足病理日常制片和染色需求,全流程无二甲苯,具有环保优点,成本可控,值得推广应用。
Objective: To investigate the utilization of environmentally-sustainable reagents in ophthalmic tissue pathology techniques. Methods: We prospectively collected 190 surgical specimens submitted to the pathology department of Zhongshan Ophthalmic Center between June 2023 and March 2024. Each specimen was divided into two sets, one treated with environmentally-sustainable reagents and the other with conventional reagents for fixation, dehydration, clearing, infiltration, staining, and mounting. The quality of histological sections from both groups was evaluated and compared. Results: Compared to the conventional reagent group, environmentally-sustainable reagent group showed good dehydration performance, moderately soft and hard tissue sections with intact cut surfaces and no cracks. H&E staining sections prepared with environmentally-sustainable reagents exhibited clear nuclear structures, distinct nuclear-cytoplasmic contrast, and clean backgrounds. The excellent section rates were 97.9% and 98.4% for the two, respectively. There was no significant difference in section quality between the two groups (Z = –0.645, P = 0.519). Tissue antigenicity was well-preserved during immunohistochemical procedures, with strong positive signals and accurate localization without background staining. Conclusions: The use of environmentally-sustainable reagents as a replacement for conventional reagents in the dehydration and staining of ophthalmic tissue yields satisfactory results, meeting the daily requirements for routine histological sectioning and staining. The entire process is xylene-free, environmentally-sustainable, cost-effective and worth being applied widely.
目的:了解干眼患者相关知识、管理态度及防治行为的现状及影响因素,为临床制定针对性的干预措施提供依据。方法:采用便利抽样法,选取2025年1—3月在中山大学中山眼科中心干眼与眼表疾病门诊就诊的患者为研究对象。调查工具为一般资料调查表、中国干眼问卷及干眼患者知信行问卷。知信行问卷包括知识(16个条目)、态度(7个条目)、行为(9个条目) 3个维度,共32个条目。使用单因素分析及多元线性回归分析确定影响因素。 结果:有效回收调查问卷325份,325例干眼患者的知信行问卷平均得分为(62.89±9.00)分;标准分为(78.61±11.25)分,处于中等水平。其中知识维度平均得分为(9.89±4.88)分,134例(41.2%)处于较差水平;态度维度得分较高,总均分为(26.92±2.24)分,标准分(96.16±8.03)分,处于较高水平;行为维度总均分为(26.06±5.43)分,标准分(72.41±15.09)分,处于中等水平。单因素分析结果显示,不同年龄、文化程度、家庭人均月收入、是否经常使用电子设备、是否主动查询疾病知识的干眼患者,其知信行得分比较差异有统计学意义(P<0.05)。年龄、文化程度、是否主动查询疾病知识是干眼患者知信行得分的影响因素(P<0.05)。 结论:干眼患者知信行水平处于中等,表现为疾病知识掌握片面、防治态度较积极但行为水平有待提高,且受多因素影响,应制订精准、个性化健康教育内容,以提高干眼患者的知信行水平。
Objective: To investigate the current status and identify the influencing factors regarding the knowledge, attitudes, and practices related to dry eye disease (DED) among patients. This study aims to provide a solid foundation for the development of targeted clinical interventions. Methods: With convenience sampling, patients diagnosed with DED were selected at the Dry Eye and Ocular Surface Disease Clinic of Zhongshan Ophthalmic Center from January to March 2025 as study subjects. The survey tools consisted of a general information questionnaire, the Chinese Dry Eye Questionnaire, and the Knowledge, Attitudes, and Practices (KAP) Questionnaire for DED patients. The KAP questionnaire was structured into three dimensions: knowledge (16 items), attitudes (7 items), and practices (9 items), making a total of 32 items. Univariate analysis and multiple linear regression were employed to identify influencing factors. Results: A total of 325 valid questionnaires were collected. Among the 325 DED patients, the average KAP score was 62.89±9.00, and the standardized score was 78.61±11.25, indicating a moderate level. In the knowledge dimension, the average score was 9.89±4.88 and 134 patients (41.2%) had poor scores. The attitudes dimension showed a relatively high level, with a total mean score of 26.92±2.24 and a standardized score of 96.16±8.03, reflecting that the patients generally held positive attitudes towards the prevention and treatment of DED. For the practices dimension, the total mean score was 26.06±5.43, and the standardized score was 72.41±15.09, indicating a moderate level of behaviorial practices. Univariate analysis revealed significant differences in KAP scores among patients with different ages, education levels, monthly household income per capita, frequencies of electronic device use, and whether they actively sought disease-related knowledge (P<0.05). Further, age, education level, and proactive information-seeking behavior were identified as significant influencing factors for KAP scores (P<0.05). Conclusions: The KAP level of DED patients is moderate. Their disease knowlege is fragmented, while they exhibit positive attitudes toward prevention and treatment. However, their behavioral practices are subptimal and are influenced by multiple factors. Therefore, it is essential to develop tailored and personalized health education programs to enhance the KAP level of DED patients.
目的:评估显微射频消融术治疗异位睫毛的临床疗效和安全性。方法:回顾性分析接受显微射频消融术治疗的18例异位睫毛患者资料,均采用美国Ellman公司Surgitron射频刀进行治疗,术后随访至少3个月。观察指标包括异位睫毛清除率、达到治愈所需治疗次数、并发症、患者满意度。采用Spearman等级相关分析评估患者基线特征与治疗次数的相关性。结果:共纳入18例患者30眼。显微射频消融术的术后即刻异位睫毛清除率达100%。5眼(16.7%)经单次治疗后达到治愈,11眼(36.7%)需要2次治疗达到治愈,13眼(43.3%)需要3次治疗达到治愈,1眼(3.3%)需要3次以上治疗达到治愈。主要并发症包括干眼13眼(43.3%)、睑缘炎症1眼(3.3%),未发现睑缘畸形、瘢痕等严重并发症。患者满意度调查显示非常满意16例(88.9%),基本满意2例(11.1%),总体满意度(非常满意+基本满意)达100%。相关性分析提示倒睫数量与达到治愈的治疗次数呈显著正相关(rs=0.672, P=0.002)。结论:显微射频消融术治疗异位睫毛具有精确定位、有效破坏毛囊、治疗时间短、创伤小、恢复快、安全性高等优点,患者满意度高,是治疗异位睫毛的有效方法。
Objective: To evaluate the clinical efficacy and safety of microscopic radiofrequency ablation in treating of distichiasis and aberrant lashes. Methods: We performed a retrospective analysis on 18 patients with trichiasis (distichiasis and aberrant lashes) who underwent microscopic radiofrequency ablation treatment. All patients were followed up for a minimum of 3 months after the operation. The outcome measures included trichiasis clearance rate, the number of treatment sessions needed to achieve success, complications, and patient satisfaction. Spearman rank correlation analysis was used to evaluate the correlation between the baseline characteristics of patients and the number of treatment sessions. Results: The study included 18 patients with a total of 30 eyes. Immediately after the operation, the trichiasis clearance rate achieved through microscopic radiofrequency ablation was 100%. Among the eyes, 5 eyes (16.7%) were successful treatment after just one session, 11 eyes (36.7%) required 2 treatment sessions, 13 eyes (43.3%) needed 3 treatment sessions, and 1 eye (3.3%) required more than 3 treatment sessions to achieve success. The major complications included dry eye in 13 cases (43.3%) and eyelid margin inflammation in 1 case (3.3%). Notably, no severe complications such as eyelid deformity or scarring were observed. According to the patient satisfaction survey, 16 cases (88.9%) reported being very satisfied, and 2 cases (11.1%) were basically satisfied, resulting in an overall satisfaction rate of 100%. The correlation analysis indicated that the number of trichiatic eyelashes was significantly positively correlated with the number of treatment sessions (rs=0.672, P=0.002). Conclusions: Microscopic radiofrequency ablation for distichiasis and aberrant lashes treatment boasts serveral advantages, including precise localization, effective destruction of hair follicle, short treatment duration, minimal trauma, rapid recovery, and high safety. With a high level of patient satisfaction, it serves as an effective treatment method for distichiasis and aberrant lashes.
目的:探索采用一眼眼罩联合另一眼眼垫的改良包眼方式对斜视患者双眼矫正术后恢复期生活质量及焦虑情绪的影响。 方法:于2024年9—10月在中山大学中山眼科中心招募日间手术接受双眼斜视矫正术的患者80例,按入院时间单双周分为联合眼罩组和眼垫组,每组各40例。联合眼罩组在手术肌肉少的眼睛或主导眼佩戴多小孔塑料眼罩,另一眼用眼垫包眼;眼垫组采用双眼眼垫包眼。主要结局指标为术后1 d的视功能相关生活质量。次要结局指标包括术后1 d的睡眠评分、疼痛评分、球结膜充血水肿、切口外观及术后1周患者满意度。 结果:两组患者在性别、年龄、术前斜视情况和斜视手术肌肉条数等基线特征分布的差异无统计学意义(P>0.05)。联合眼罩组术后1 d视功能相关生活质量、睡眠和术后1周患者满意度均优于眼垫组,差异具有统计学意义(P<0.05)。两组患者在术后1 d疼痛程度、球结膜充血、切口外观、斜视改善程度的比较,差异无统计学意义(P>0.05);结论:斜视双眼矫正术后采用一眼眼罩联合一眼眼垫遮盖的方式,在保证术后恢复效果的同时,能够有效改善患者术后视功能相关生活质量和睡眠质量,并提升患者满意度。
Objective:To investigate the effects of a modified eye-patching technique, which combines the use of an eye shield on one eye and an eye patch on the other, on the quality of life and anxiety levels of strabismus patients during the recovery period after binocular correction surgery. Methods: A total of 80 patients who underwent bilateral strabismus correction as day surgery at our hospital between September and October 2024 were recruited for this study. Based on whether their admission week was odd or even, they were randomly assigned to two groups: the combined patching group (n=40) and the conventional patching group (n=40). In the combined patching group, patients wore a multiple-aperture plastic eye shield on the eye with fewer operated muscles or the dominant eye, while the other eye was covered with a conventional eye patch. In the conventional patching group, patients received bilateral eye patches. The primary outcome measure was vision-related quality of life on the first postoperative day. Secondary outcomes included the sleep quality score, pain score, conjunctival hyperemia and edema, incision appearance on the first postoperative day, and patient satisfaction one week after surgery. Results: There were no statistically significant differences in baseline characteristics, such as gender, age, preoperative strabismus status, or the number of operated muscles, between the two groups. Compared to the conventional patching group showed significantly better vision-related quality of life and sleep quality on the first postoperative day, as well as higher patient satisfaction one week after surgery (P< 0.05). On the first postoperative day, there were no significant differences between the two groups in pain level, conjunctival hyperemia, incision appearance, or degree of strabismus improvement (P > 0.05). Conclusions: The application of a modified eye-covering method, which combines an eye shield on one eye and an eye patch on the other, after bilateral strabismus correction surgery, can effectively enhance postoperative vision-related quality of life and sleep quality. Moreover, it can maintain recovery outcomes and increase patient satisfaction. This approach holds clinical value and is worthy of wider promotion.
目的:探讨并分析青光眼患者积极度的潜在剖面及其关联因素,为临床制订精准干预策略提供实证依据。方法:采用横断面调查法,选取2024年7—10月在中山大学中山眼科中心就诊的202例青光眼患者 为研究对象。研究工具包括一般资料调查表、患者积极度量表、一般自我效能量表及领悟社会支持量 表,应用Mplus 8.3软件进行潜在剖面分析,并采用多因素回归模型探索不同类别患者的社会人口学、疾病相关及心理社会相关因素。 结果:青光眼患者积极度分为两个潜在剖面:“高激活度-主动适应型” (33.66%)、“低激活度-应对依赖型”(66.34%)。多因素分析结果显示,居住地为城市、月收入较高、晚期视野缺损、手术次数≥3次、一般自我效能较高以及社会支持水平较好的患者,更可能归属于“高激活 度-主动适应型” (P<0.05)。结论:青光眼患者积极度整体处于中等偏下水平,以“低激活度–应对依赖 型”为主导。提示医护人员应重视青光眼患者积极度的评估,并基于潜在类别及相关因素,从增强自 我效能、拓展社会支持、加强健康教育等方面入手,为不同类别患者制订个性化、有针对性的干预方 案,从而有效提升青光眼患者的积极度水平及其疾病自我管理能力,以期改善长期治疗依从性与生活质量。
Objective: To explore and analyze the latent profiles of glaucoma patient activation and their associated factors, providing empirical evidence for developing precise clinical intervention strategies. Methods: A cross-sectional survey was conducted, involving 202 glaucoma patients recruited from Zhongshan Ophthalmic Center, Sun Yat-sen University, between July and October 2024. The study utilized the General Information Questionnaire, the Patient Activation Measure, the General Self-Efffcacy Scale, and the Perceived Social Support Scale. Latent proffle analysis was performed using Mplus 8.3 software to identify distinct profiles of patient activation, and a multivariate regression model was employed to explore the sociodemographic, disease-related, and psychosocial factors associated with different proffles. Results: TTe patient activation in glaucoma patients was categorized into two latent proffles: "High Activation–Active Adaptation Type" (33.66%) and "Low Activation–Coping Dependent Type" (66.34%). Multivariate analysis revealed that patients who were urban residents, had higher monthly income, presented with advanced visual field defects, underwent three or more surgeries, reported higher general self-efffcacy, and had better perceived social support were more likely to belong to the "High Activation–Active Adaptation Type" (P<0.05). Conclusions: TTe overall level of patient activation in glaucoma patients is moderate to low, predominantly characterized by the "Low Activation–Coping Dependent Type." TTis suggests that healthcare professionals should prioritize the assessment of patient activation in glaucoma care. Based on the identiffed latent proffles and their associated factors, personalized and targeted intervention strategies—such as enhancing self-efffcacy, expanding social support, and strengthening health education—should be developed for different patient subtypes. TTese efforts are essential to effectively improve patient activation levels and disease self-management capabilities, thereby enhancing long-term treatment adherence and quality of life.
年龄相关性黄斑变性(age-related macular degeneration, AMD)是一种与氧化应激及多基因调控异常密切相关的视网膜黄斑区域进行性退化性疾病。由于黄斑区缺乏血管,因此对氧气的高度依赖使其特别容易受到氧化应激的影响。氧化应激反应影响视网膜色素上皮细胞(retinal pigment epithelium, RPE)功能,导致RPE细胞代谢异常、RPE细胞凋亡与损伤;影响脉络膜血管功能,表现为新生血管异常和血管内皮细胞功能障碍;过度激活补体系统,使炎症细胞浸润与炎症因子释放引发炎症;这三者构成了AMD的发病机制之一。文章列举了抗氧化酶基因家族(超氧化物歧化酶、过氧化氢酶、谷胱甘肽过氧化物酶)、炎症相关基因(补体系统相关基因和细胞因子相关基因)和其他相关基因(血管内皮生长因子、血红素加氧酶-1、载脂蛋白E、铁死亡相关基因、年龄相关性黄斑病变易感因子2基因)的异常表达与AMD产生的关联性,并阐述了基因编辑技术纠正氧化应激相关基因缺陷和基于氧化应激基因靶点的药物治疗手段,以期为AMD的防治提供思路。
Age-related macular degeneration (AMD) is a retinal degenerative disease closely associated with oxidative stress and dysregulation of polygenic mechanisms. Due to the absence of blood vessels in the macular region, its high dependence on oxygen renders it particularly susceptible to oxidative stress. Oxidative stress impairs the function of retinal pigment epithelium (RPE) cells, leading to metabolic dysregulation, apoptosis, and cellular damage. It also disrupts choroidal vascular function, characterized by abnormal neovascularization and endothelial dysfunction. Moreover, excessive activation of the complement system promotes inflammatory cell infiltration and the release of pro-inflammatory cytokines. Collectively, these processes constitute one of the key pathogenic mechanisms underlying AMD. This paper highlights the pathogenic associations between AMD progression and dysregulated expression in antioxidant enzyme genes (e.g., superoxide dismutase, catalase, glutathione peroxidase), inflammation-related genes (e.g., complement and cytokine-related genes), and other relevant genes (e.g., vascular endothelial growth factor, heme oxygenase-1, apolipoprotein E, ferroptosis-related genes, age-related maculopathy susceptibility 2 gene). Potential therapeutic strategies, including gene editing to correct oxidative stress-related genetic defects and pharmacological interventions targeting oxidative stress-associated genes, are also elaborated, aiming to provide new insights into AMD prevention and treatment.
脂质运载蛋白2(LCN2/NGAL)是一种多效性分泌糖蛋白,通过调控铁代谢、炎症反应及细胞死亡(铁死亡、凋亡)等机制,广泛参与眼科疾病的病理进程。生理状态下,LCN2在角膜上皮、视网膜神经节细胞层等部位低表达;病理条件下,其表达显著上调且功能呈现高度背景依赖性。在各类眼科疾病(如干眼症、角膜疾病、葡萄膜炎、青光眼、视网膜疾病等)中,既可表现为促炎促凋亡的致病因子,亦能发挥抗炎保护作用。靶向调控LCN2表达或其下游通路可能为眼科疾病治疗提供新策略。
Lipocalin-2 (LCN2/NGAL) is a multifunctional secretory glycoprotein that plays a critical role in the pathogenesis of ophthalmic diseases by regulating iron metabolism, inflammatory responses, and cell death pathways (ferroptosis, apoptosis). Under physiological conditions, LCN2 is expressed at low levels in tissues such as the corneal epithelium and retinal ganglion cell layer. However, its expression is significantly upregulated under pathological conditions, exhibiting highly context-dependent functionality. In major ophthalmic diseases—including dry eye disease, corneal disorders, uveitis, glaucoma, and retinal diseases—LCN2 can act either as a pro-inflammatory and pro-apoptotic pathogenic factor or as an anti-inflammatory protective agent. Targeted modulation of LCN2 expression or its downstream pathways may offer novel therapeutic strategies for ocular diseases.
全眼球移植(Whole eye transplantation, WET)是治疗因外伤、肿瘤等导致眼球不可逆损伤及永久性失明的潜在终极手段。其核心不仅在于实现眼球解剖结构的完整移植,更关键的是实现功能性视觉恢复,关键挑战包括优化手术策略重建眼球血液循环,实现供体视神经与受体视觉中枢的神经连接,建立精准有效的免疫调控策略以平衡移植耐受与感染风险。本文系统梳理了WET领域的研究进展与发展挑战。早期研究以变温动物模型为主,这些模型在一定程度上证实了视觉通路在眼球移植后仍具有一定的可塑性,但由于其眼球结构与人类存在显著解剖差异,且实验设计中未涉及精细的血管与神经吻合,因而临床转化价值有限。随着显微血管技术的发展,哺乳动物模型及人眼球移植的初步探索在显微外科血管吻合技术方面取得重要突破,实现了移植眼球视网膜血液灌注的短期重建,但仍面临视神经再生障碍和功能维持难题。当前的研究瓶颈主要集中在三个方面:血液循环重建技术优化、神经轴突精准再生及免疫微环境调控。建立与人类接近的标准化非人灵长类动物模型,并开展系统性的实验研究,将为克服现有技术障碍、推动WET走向临床提供至关重要的实验依据和新思路。
Whole eye transplantation (WET) is a potential definitive treatment for irreversible ocular damage and permanent blindness caused by conditions like trauma or tumors. The success of WET depends not only on the complete anatomical restoration of the transplanted eye but, more critically, on the recovery of functional vision. Key challenges in this field include optimizing surgical strategies to re-establish ocular blood circulation, achieving functional neural integration between the donor optic nerve and the recipient's visual centers, and developing precise and effective immunomodulation strategies to strike a balance transplant tolerance and infection risk. This review provides a systematic review of the research progress and developmental challenges in the field of WET. Early studies primarily utilized poikilothermic animal models, which demonstrated a certain degree of plasticity in the visual pathway following transplantation. However, due to significant anatomical differences compared to humans and the lack of sophisticated vascular and neural anastomosis in experimental designs, their clinical translatability of these studies remained constrained. With the progress in microvascular techniques, preliminary explorations in mammalian models and human eye transplantation have achieved significant breakthroughs in microsurgical vascular anastomosis, enabling the short-term reestablishment of retinal blood perfusion in transplanted eyes. Nonetheless, perisitent obstacles include inadequate optic nerve regeneration and poor long-term functional maintenance. Currently, research bottlenecks mainly focus on three aspects: optimizing surgical techniques for blood circulation reconstruction, precisely regenerating nerve axons, and regulating the immune microenvironment. Establishing standardized non-human primate models that closely mimic humans and conducting systematic experimental studies will furnish crucial evidence and novel insights to overcome existing technical hurdles and propel WET toward clinical application.