[A multicenter study on respiratory pathogen detection with Mycoplasma pneumoniae pneumonia in children].

Objective: To analyze the status of respiratory pathogen detection and the clinical features in children with Mycoplasma pneumoniae pneumonia (MPP). Methods: A prospective, multicenter study was conducted to collect clinical data, including medical history, laboratory examinations and multiplex PCR tests of children diagnosed with MPP from 4 hospitals in China between November 15th and December 20th, 2023. The multiplex PCR results and clinical characteristics of MPP children in different regions were analyzed. The children were divided into severe and mild groups according to the severity of the disease. Patients in the severe group were further divided into Mycoplasma pneumoniae (MP) alone and Multi-pathogen co-detection groups based on whether other pathogens were detected besides MP, to analyze the influence of respiratory pathogen co-detection rate on the severity of the disease. Mann-Whitney rank sum test and Chi-square test were used to compare data between independent groups. Results: A total of 298 children, 136 males and 162 females, were enrolled in this study, including 204 children in the severe group with an onset age of 7.0 (6.0, 8.0) years, and 94 children in the mild group with an onset age of 6.5 (4.0, 7.8) years. The level of C-reactive protein, D-dimer, lactic dehydrogenase (LDH) were significantly higher (10.0 (5.0, 18.0) vs. 5.0 (5.0, 7.5) mg/L, 0.6 (0.4, 1.1) vs. 0.5 (0.3, 0.6) mg/L, 337 (286, 431) vs. 314 (271, 393) U/L, Z=2.02, 2.50, 3.05, all P<0.05), and the length of hospitalization was significantly longer in the severe group compared with those in mild group (6.0 (6.0, 7.0) vs. 5.0 (4.0, 6.0) d, Z=4.37, P<0.05). The time from onset to admission in severe MPP children was significantly shorter than that in mild MPP children (6.0 (5.0, 9.5) vs. 9.0 (7.0, 13.0) d, Z=2.23, P=0.026). All patients completed the multiplex PCR test, with 142 cases (47.7%) MPP children detected with 21 pathogens including adenovirus 25 cases (8.4%), human coronavirus 23 cases (7.7%), rhinovirus 21 cases (7.0%), Streptococcus pneumoniae 21 cases (7.0%), influenza A virus 18 cases (6.0%). The pathogens with the highest detection rates in Tianjin, Shanghai, Wenzhou and Chengdu were Staphylococcus aureus at 10.7% (8/75), adenovirus at 13.0% (10/77), adenovirus at 15.3% (9/59), and both rhinovirus and Haemophilus influenzae at 11.5% (10/87) each. The multi-pathogen co-detection rate in severe MPP children was significantly higher than that in mild MPP group (52.9% (108/204) vs. 36.2% (34/94), χ²=10.62,P=0.005). Among severe MPP children, there are 89 cases in the multi-pathogen co-detection group and 73 cases in the simple MPP group. The levels of LDH, D-dimer and neutrophil counts in the multi-pathogen co-detection group were significantly higher than those in the simple MPP group (348 (284, 422) vs. 307 (270, 358) U/L, 0.8 (0.5, 1.5) vs. 0.6 (0.4, 1.0) mg/L, 4.99 (3.66, 6.89)×109 vs. 4.06 (2.91, 5.65)×109/L, Z=5.17, 4.99, 6.11, all P<0.05). Conclusions: The co-detection rate of respiratory pathogens, LDH and D-dimer in children with severe MPP were higher than those with mild MPP. Among severe MPP children the stress response of children in co-detection group was more serious than that of children with simple MPP.

[Development of an asthenopia survey questionnaire for general surveys].

Objective: To design a visual fatigue questionnaire that can be used for population surveys. Methods: This was a cross-sectional study that involved three stages of subjects' recruitment. In the first stage, by convenience sampling, 150 individuals who complained of visual fatigue were selected at public places in Wenzhou City in May 2016. The 19-Item Asthenopia Survey Questionnaire (ASQ-19) was used to conduct the survey, and the questionnaire was adjusted. In the second stage, 200 outpatient participants were recruited from Wenzhou Medical University Affiliated Eye and Optometry Hospital from June 2016 to May 2017 and were divided into a visual fatigue group and a control group based on clinical diagnosis. The adjusted visual fatigue questionnaire was used for validation. In the third stage, 64 outpatient participants who met the inclusion criteria were continuously recruited from the Wenzhou Medical University Affiliated Eye and Optometry Hospital in July 2022. They were tested using the adjusted visual fatigue questionnaire and retested one week later. During the questionnaire adjustment stage, factor analysis and feedback were used to adjust the scoring method and items of the ASQ-19 questionnaire. The adjusted questionnaire was then analyzed for reliability, validity, accuracy, and subject acceptance during the validation and retest stages. Results: A total of 403 participants were included, and 456 questionnaires were distributed. Eventually, 432 valid questionnaires were collected from 379 participants, resulting in a valid response rate of 94.7%. During the questionnaire adjustment phase, there were 140 valid questionnaires from 140 participants consisting of 56 males and 84 females with an average age of (35.2±12.4) years. In the questionnaire validation phase, there were 186 valid questionnaires from 186 participants. Sixty-two participants had visual fatigue and 124 were controls. During the questionnaire retesting phase, 53 participants yielded 106 valid questionnaires. The group consisted of 20 males and 33 females with an average age of (22.8±4.9) years. After factor analysis, the symptom severity graded as none, mild, moderate, severe, and very severe was scored as 0, 1, 2, 3, and 4 points, respectively. The total score was 44, and the final questionnaire consisted of 11 items (numbered 1, 2, 3, 5, 6, 8, 10, 15, 17, 18, and 19). The 11-Item Asthenopia Survey Questionnaire (ASQ-11) had a Cronbach's α coefficient of 0.89, a split-half reliability of 0.82, and a test-retest Pearson correlation coefficient of 0.90 (P<0.001). The structural validity was 51.26%, and the discriminative validity was a t-value of 9.19 (P<0.001). On average, it took (2.82±0.43) minutes for participants to complete the questionnaire. The receiver operating characteristic curve had a cutoff value of 8.5, with a sensitivity of 74.19% and a specificity of 80.65%. Conclusion: The ASQ-11, with fewer items and a shorter completion time, is easy for participants to use and is suitable for screening or self-assessment of visual fatigue in the general population. Additionally, it is convenient for clinical and epidemiological studies related to visual fatigue.

[Analysis of the clinical features and the risk factors of severe human metapneu movirus-associated community acquired pneumonia in children].

Objective: To investigate the clinical characteristics and the risk factors of severe human metapneumovirus (hMPV)-associated community acquired pneumonia (CAP) in children. Methods: A retrospective case summary was conducted. From December 2020 to March 2022, 721 children who were diagnosed with CAP and tested positive for hMPV nucleic acid by PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at the Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects. The clinical characteristics, epidemiological characteristics and mixed pathogens of the two groups were analyzed. According to CAP diagnostic criteria, the children were divided into the severe group and the mild group. Chi-square test or Mann-Whitney rank and contrast analysis was used for comparison between groups, while multivariate Logistic regression was applied to analyze the risk factors of the severe hMPV-associated CAP. Results: A total of 721 children who were diagnosed with hMPV-associated CAP were included in this study, with 397 males and 324 females. There were 154 cases in the severe group. The age of onset was 1.0 (0.9, 3.0) years, <3 years old 104 cases (67.5%), and the length of hospital stay was 7 (6, 9) days. In the severe group, 67 children (43.5%) were complicated with underlying diseases. In the severe group, 154 cases (100.0%) had cough, 148 cases (96.1%) had shortness of breath and pulmonary moist rales, and 132 cases (85.7%) had fever, 23 cases (14.9%) were complicated with respiratory failure. C-reactive protein (CRP) was elevated in 86 children (55.8%), including CRP≥50 mg/L in 33 children (21.4%). Co-infection was detected in 77 cases (50.0%) and 102 strains of pathogen were detected, 25 strains of rhinovirus, 17 strains of Mycoplasma pneumoniae, 15 strains of Streptococcus pneumoniae, 12 strains of Haemophilus influenzae and 10 strains of respiratory syncytial virus were detected. Six cases (3.9%) received heated and humidified high flow nasal cannula oxygen therapy, 15 cases (9.7%) were admitted to intensive care unit, and 2 cases (1.3%) received mechanical ventilation. In the severe group, 108 children were cured, 42 children were improved, 4 chlidren were discharged automatically without recovery and no death occurred. There were 567 cases in the mild group. The age of onset was 2.7 (1.0, 4.0) years, and the length of hospital stay was 4 (4, 6) days.Compared with the mild group, the proportion of children who age of disease onset <6 months, CRP≥50 mg/L, the proportions of preterm birth, congenital heart disease, malnutrition, congenital airway malformation, neuromuscular disease, mixed respiratory syncytial viruses infection were higher (20 cases (13.0%) vs. 31 cases (5.5%), 32 cases (20.8%) vs. 64 cases (11.3%), 23 cases (14.9%) vs. 44 cases (7.8%), 11 cases (7.1%) vs. 18 cases (3.2%), 9 cases (5.8%) vs. 6 cases (1.1%), 11 cases (7.1%) vs. 12 cases (2.1%), 8 cases (5.2%) vs. 4 cases (0.7%), 10 cases (6.5%) vs. 13 cases (2.3%), χ2=0.42, 9.45, 7.40, 4.94, 11.40, 8.35, 3.52, 6.92, all P<0.05). Multivariate Logistic regression analysis showed that age<6 months (OR=2.51, 95%CI 1.29-4.89), CRP≥50 mg/L (OR=2.20, 95%CI 1.36-3.57), prematurity (OR=2.19, 95%CI 1.26-3.81), malnutrition (OR=6.05, 95%CI 1.89-19.39) were the independent risk factors for severe hMPV-associated CAP. Conclusions: Severe hMPV-associated CAP is most likely to occur in infants under 3 years old and has a higher proportion of underlying diseases and co-infection. The main clinical manifestations are cough, shortness of breath and pulmonary moist rales, fever. The overall prognosis is good. Age<6 months, CRP≥50 mg/L, preterm birth, malnutrition are the independent risk factors for severe hMPV-associated CAP.

Dynamical diffraction of high-energy electrons investigated by focal series momentum-resolved scanning transmission electron microscopy at atomic resolution.

We report a study of scattering dynamics in crystals employing momentum-resolved scanning transmission electron microscopy under varying illumination conditions. As we perform successive changes of the probe focus, multiple real-space signals are obtained in dependence of the shape of the incident electron wave. With support from extensive simulations, each signal is shown to be characterised by an optimum focus for which the contrast is maximum and which differs among different signals. For instance, a systematic focus mismatch is found between images formed by high-angle scattering, being sensitive to thickness and chemical composition, and the first moment in diffraction space, being sensitive to electric fields. It follows that a single recording at one specific probe focus is usually insufficient to characterise materials comprehensively. Most importantly, we demonstrate in experiment and simulation that the second moment µ20+µ02=〈p2〉 of the diffracted intensity exhibits a contrast maximum when the electron probe is focused at the top and bottom faces of the specimen, making the presented concept attractive for measuring local topography. Given the versatility of 〈p2〉, we furthermore present a detailed study of its large-angle convergence both analytically using the Mott scattering approach, and by dynamical simulations using the multislice algorithm including thermal diffuse scattering. Both approaches are in very good agreement and yield logarithmic divergence with increasing scattering angle.

[A cross-sectional study of renal dysfunction in chronic hepatitis B outpatients treated with nucleos(t)ide drugs in China].

Objective: To compare the proportion of abnormal renal function indexes in outpatients with chronic hepatitis B (CHB), and to further explore the correlation between the history of nucleos(t)ide analogues (NA) antiviral therapy and abnormal renal function indexes. Methods: A cross-sectional design was adopted for renal function screening. Baseline characteristics, history of antiviral treatment, and renal function indexes were collected, including glomerular filtration rate (eGFR), blood urea nitrogen, blood creatinine, blood uric acid, and urine ß2- microglobulin α 1-microglobulin and urinary protein. According to the definition and standard of abnormal renal function indexes, the correlation between chronic kidney disease (CKD) - 1/2 and related risk factors, renal tubular indicators and risk factors, and the correlation between antiviral treatment duration and renal tubular risk were analyzed. The data were analyzed by single and multi-factor regression. Results: 2703 outpatients from 47 hospitals across the country were enrolled. 70.7% were males with an average age of 47.5 years. 15.5% of cases had hypertension, 14.6% cases had chronic kidney disease, 11.3% cases had diabetes, and 15.4% had CKD 1/2. Retinol-binding protein, urinary ß2-microglobulin or urinary α1-microglobulin showed renal tubular damage rates of 10.4%, 27.1% and 18.4%, respectively. Renal tubular damage risk was related to the antiviral treatment duration (OR = 1.06, 95% CI = 1.028 ~ 1.093). Multivariate analysis results showed that the risk factors related to eGFR < 90 ml/min in male were 40-60 or > 60 years old, high viral load, poorly controlled hypertension, use of nephrotoxic drugs, liver fibrosis status, family history of hepatitis B; while the risk factors related to eGFR < 60 ml/min in female were decompensated cirrhosis, poorly controlled diabetes, and family history of hepatitis B. Conclusion: CHB outpatients have a high proportion of chronic kidney damage, including early renal tubular damage, which suggests that baseline renal function should be assessed before NA use and closely monitored during the treatment. Regular monitoring of the renal tubular damage index can detect the risk of kidney damage earlier than the estimated eGFR.

[Epidemiology of myopia: iteration and progression].

Adolescent myopia has become one of the researchers' focuses among visual problems around the world. Carrying out a scientific and efficient epidemiological study on myopia is an essential basis for discovering the rules of the occurrence and the development of myopia, exploring related influencing factors and identifying the mechanisms, which are critical for the policy-making for myopia control. The epidemiological studies of myopia at home and abroad have a long history of exploration, standardization and unification, and are enriched by new technologies and up-to-date discoveries. Based on the characteristics of social development and the prevalence of adolescent myopia in the past six decades, the epidemiological studies on myopia are divided into four stages in this article. Each stage is specified and analyzed to identify the difference in research methods and strategies. The main scientific issues and research elements in the current epidemiology of myopia in adolescents are put forward. (Chin J Ophthalmol, 2021, 57:245-250).

[A new valid and reliable questionnaire of asthenopia: development and evaluation].

Objective: To design a valid and reliable questionnaire to determine various causes of asthenopia for use by clinicians and researchers. Methods: The items to be included in the first version questionnaire were selected based on its definition and literature review. The second version was improved from patients interviews and the Delphi method. In this phase, 17 experts, 97 patients [47 males, 50 females, age (34.42±14.62) years old] with asthenopia and 20 controls [9 males, 11 females, age (33.50±7.31) years old] were involved to generated item list. In the Validation phase, we conducted two round interview through 275 asthenopia patients [97 males,186 females,age (34.42±14.62) years old] and 49 controls [17 males,32 females,age (35.79±8.88) years old]for item reduction and questionnaire validity and reliability assessment. Exploratory factor analysis was performed to reduce items and derive the subscale that each item belongs to. Internal consistency was calculated for all resulting subscales, using Cronbach's α coefficient, spilt-half reliability and repeatability. The repeatability of the questionnaire was measured by Pearson correlation analysis. Results: Our initial questionnaire contained 52 symptoms and 2 self-evaluation questions. After the item reduction and assessment, 19 items were selected and classified into three domains through factor analysis. Cronbach α for the three subscales of this version was between 0.79 and 0.85, while for the complete questionnaire it was 0.90, with a spilt-half reliability of 0.80. Factor analysis showed the three components had eigenvalues>3 and these explained 54.3% of the variance. Conclusions: The 19-item asthenopia questionnaire has acceptable psychometric properties, making it a valid and reliable tool for ophthalmologists and optometrists to evaluate asthenopia as well as to seek causes. It has the potential to be used in clinical trials and outcome research. (Chin J Ophthalmol, 2021, 57:284-291).

[Correlation between the expression profile of cytokeratin 19/glypican 3 and recurrence of hepatocellular carcinoma after interventional therapy].

Objective: To observe the correlation between the expressions profile of cytokeratin 19/glypican 3 (CK19/GPC3) and recurrence of hepatocellular carcinoma after interventional therapy. Methods: Clinical and pathological information of 251 eligible cases with hepatocellular carcinoma who underwent interventional therapy in You'an Hospital from November 2007 to May 2016 were retrospectively collected. Univariate and multivariate Cox regression analysis was used to analyze the relevant risk factors that may affect their prognosis. Kaplan-Meier survival analysis was used to draw the survival curve. Log-rank test was used to compare the difference in survival rates between the groups. Results: Kaplan-Meier univariate analysis showed that histological grade, CK19/GPC3 expression profile, alpha-fetoprotein level and Hep Parl were closely related to tumor recurrence. Multivariate Cox regression analysis showed CK19/GPC3 expression profile (HR = 1.634, 95%CI: 1.041 ~ 2.564, P = 0.033), histological grade (HR = 1.445, 95%CI: 1.037 ~ 2.014, P = 0.030), alpha-fetoprotein level (HR = 1.410, 95%CI: 1.042 ~ 1.908, P = 0.026), Hep Parl (HR = 0.570, 95%CI: 0.349 ~ 0.930, P = 0.025) were the four independent factors for prediction of recurrence after interventional therapy. Conclusion: Hepatocellular carcinoma patients with CK19(+)/GPC3(+) and CK19(-)/GPC3(+) phenotypes who meet the Milan criteria have a higher risk of recurrence after interventional therapy than CK19(-)/GPC3(-) phenotypes.

[A summary of China's 70 years of development in optometric technology].

Since the founding of the People's Republic of China, the optometric technology has developed rapidly. Our peers have created breakthroughs in the field exploration and technology evolution, which have made the optometric technology in China reach the highest level in the world. We review the development and driving force of optometric technology in our country. We would like to send congratulations on the 70th anniversary of Chinese Journal of Ophthalmology with this article. (Chin J Ophthalmol, 2020, 56:721-725).

[Potential clinical value of new type of HBV serological markers ranking in the review column].

Liver fibrosis, liver cirrhosis and hepatocellular carcinoma caused by chronic hepatitis B are still the main diseases that seriously affect the health of Chinese population. Notably, even if serum HBV-DNA cannot be detected after treatment, many patients will still develop liver disease. Therefore, in addition to the quantitative analysis of HBV-DNA and HBsAg, other new serological markers should be sought to facilitate the selection of CHB antiviral drugs and methods, monitoring efficacy and follow-up, efficacy prediction, and the risks of viral rebound after drug withdrawal. This article focuses on three new serological markers, namely HBcrAg, HBV-RNA and anti-HBc, with a view to applying them in clinical practice.

[Clinical analysis of mediastinal lymph node dissection through sternotomy approach in the treatment of papillary thyroid carcinoma with mediastinal lymph node metastasis].

Objective: To investigate the rule of mediastinal lymph node metastasis of papillary thyroid carcinoma and the application of therapeutic mediastinal lymph node dissection through the sternotomy approach in the treatment of mediastinal lymph node metastasis of papillary thyroid carcinoma. Methods: All cases of papillary thyroid carcinoma with mediastinal lymph node metastasis treated through sternotomy cooperated by thoracic surgeons and head and neck surgeons from January 2006 to January 2017 in Cancer Hospital of Chinese Academy of Medical Sciences were included in this study. The distribution, metastasis rate, metastasis degree, surgical method, surgical complications and postoperative survival of patients with mediastinal lymph node metastasis were retrospectively analyzed. Results: A total of 31 patients (16 males and 15 females) with papillary thyroid cancer with mediastinal lymph node metastasis, with a median age of 46 (19-65) years, were enrolled in the group. Partial upper sternotomy was used in 28 cases, and total sternotomy was used in 3 cases. The mediastinal lymph nodes of papillary thyroid carcinoma metastasized farthest to the station 6, and the lymph node metastasis rate of each group from high to low was: 2R (61%), 1R (39%), 3A (39%), 1L (16%), 2L (10%), 4R (10%), 5 (3%) and 6 (3%). No metastasis was observed in station 3P, 4L and 7. In addition, the degree of lymph node metastasis at station 2R was the highest, reaching 35% (77/219). Extra-nodal invasion of mediastinal metastatic lymph nodes in thyroid papillary carcinoma is common (23%), easily fuses into masses (23%) and invades peripheral vascular nerves (26%). Up to 29% of blood transfusions are required during or after surgery due to oozing or bleeding (9/31). The 1-, 3-, 5-and 10-year survival rates of patients undergoing surgical treatment were 94%, 94%, 87% and 81%, respectively. Conclusion: Papillary thyroid carcinoma can metastasize to almost all mediastinal lymph nodes except station 3P, 4L and 7. Radical mediastinal lymph node dissection through sternotomy is an effective method for the treatment of mediastinal lymph node metastasis of thyroid papillary carcinoma.

[Heterogeneity in PD-L1 expression on infiltrating immune cells between the primary and metastatic breast cancers].

Objective: To investigate the expression difference in PD-L1 on mesenchymal infiltrating immune cells between the primary and metastatic breast cancers, and to explore its relationship with clinicopathological parameters. Methods: All cases of primary breast cancer and their matched metastases diagnosed at the Fourth Hospital of Hebei Medical University between January 2010 and December 2018 were included. Immunohistochemistry (IHC) was used to detect the expression of PD-L1 (SP142) in interstitial infiltrating immune cells, and the expression of ER, PR, HER2 and Ki-67 in primary and matched metastases was detected. Statistical software SPSS 24.00 was used for statistical analysis. Kappa test was used for concordance/agreement analysis and McNemar test for difference analysis. Results: Among the 140 identified primary breast cancers, there were 52 cases with matched lymph node metastasis, 88 cases with distant metastasis, including 35 cases with liver metastasis, 21 cases with lung metastasis, 13 cases with chest wall metastasis, 11 cases with bone metastasis, 6 cases with brain metastasis, 1 case with small intestine metastasis, and 1 case with eyeball metastasis. The overall concordance rate of the PD-L1 expression on mesenchymal immune cells between primary breast cancer and paired metastatic breast cancer was 72.9% (κ=0.441). The concordance rate of PD-L1 expression between primary breast cancers and paired lymph node metastases, and that between primary breast cancers and distant metastases were 75.0% (κ=0.472) and 71.6% (κ=0.472), respectively. The inconcordance rate of interstitial immune cell PD-L1 expression between primary breast cancer and matched lung metastasis was 28.6%(6/21), and the difference was statistically significant (P=0.031). The expression of PD-L1 in mesenchymal immune cells of primary breast cancer was significantly correlated with tumor size, histological grade, vascular invasion, lymph node metastasis, and Ki-67 index (P<0.05). The PD-L1 expression was independently associated with lymph node metastasis (P<0.05), while the expression of PD-L1 in metastatic breast cancer interstitial immune cells was significantly related to the expression of ER (P<0.05). Conclusions: The expression of PD-L1 in the primary breast cancer is moderately concordant with that in paired metastases, but different from that in paired lung metastases. Therefore, the expression of PD-L1 in distant metastasis needs to be re-evaluated to optimize the treatment outcomes of PD-L1 based therapy.

[Study of reactive oxygen species and adiponectin for chronic HBV infection combined with nonalcoholic fatty liver diseases].

Objective: To investigate the application value of reactive oxygen species (ROS) and adiponectin (ADPN) in the judgment of liver inflammation in chronic hepatitis B virus infection combined with nonalcoholic fatty liver disease (NAFLD). Methods: A total of 159 cases with NAFLD (21 cases), chronic hepatitis B virus infection (57 cases), and chronic hepatitis B virus infection combined with NAFLD (81 cases) were collected between June 2016 to December 2018, and the visited patients diagnosis were confirmed by histopathological examination of the liver. ROS and ADPN level retained in serum was determined by enzyme-linked immunosorbent assay. Histopathological examination of liver tissue was used as the gold standard to discuss the diagnostic value of the serum in patients with chronic hepatitis B virus infection combined with NAFLD for the occurrence of nonalcoholic steatohepatitis. One-way analysis of variance was used for the comparison among multiple groups, and LSD-t test was used for pairwise comparison between groups. Measurement data for non-normal distributions were expressed as M (P25, P75). Comparisons between groups were performed using the Mann-Whitney U or Kruskal-Wallis H test. Chi-square test was used to compare the count data between groups. Correlation analysis was performed using Spearman correlation analysis. Histopathological grouping of liver tissue was used as the gold standard, and the area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the regression formula. Results: (1) In patients with chronic hepatitis B virus infection combined with NAFLD, the levels of ROS in the non-hepatic steatosis group and the mild hepatic steatosis group were significantly lower than those in the moderate and severe hepatic steatosis group, while the ADPN level in the non-hepatic steatosis group was significantly higher than liver steatosis group, P < 0.05. (2) The results of correlation analysis showed that ROS was significantly correlated with NAS score, change in the degree of fatty liver and lobular inflammation (all P < 0.05).There was a significant negative correlation between ADPN and the change in the degree of fatty liver (P < 0.05). (3) Logistic regression analysis results showed that the diagnostic formula for chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis was 0.02 × controlled attenuation index + 0.584 × white blood cells/10(9) + 0.587 × ROS-10.982. The area under receiver operating characteristic curve of the subject was = 0.896. The sensitivity, specificity, positive and negative predictive value were 97.1%, 71.2%, 64.2%, and 97.9%. Conclusion: ADPN and ROS have certain reference value in differentiating the change in the degree of fatty liver and inflammation in chronic hepatitis B virus infection combined with NAFLD and the diagnostic formula has higher application value in the diagnosis and exclusion of chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis.

[Value of serum HBV RNA in HBeAg-negative patients with chronic hepatitis B].

Objective: To analyze serum HBV-RNA levels in patients with chronic hepatitis B whose serum HBV-DNA has dropped to undetected levels after treatment with entecavir, and to explore the correlation between HBV-RNA level and liver biochemical parameters, which lay the research foundation for the clinical significance of new serological marker HBV-RNA. Methods: HBeAg negatively detected 107 cases with chronic hepatitis B whose serum HBV-DNA test results were lower than detection level for six consecutive months after receiving standard nucleoside therapy for more than 12 months were included. HBV-RNA level was detected by Perkin-Elmer reagent. HBV-DNA level was detected by Roche Cobas. Hitachi automatic biochemical analyzer was used to detect ALT and AST. Architect chemiluminescence analyzer was used to detect HBsAg, HBeAg, anti-HBe and anti-HBc. RStudio software was performed to analyze the correlation between HBV-RNA level and liver biochemical parameters. Logistic regression was used to analyze the independent factors influencing HBV-RNA level. Results: The positive detection rate of serum HBV-RNA in patients with chronic hepatitis B whose serum HBV-DNA had dropped to undetected levels after ETV treatment was 22.43%. HBsAg, ALT and AST levels in HBV-RNA positive group were slightly higher than HBV-RNA negative group, while anti-HBc levels were slightly higher in HBV-RNA negative group. There was no difference in the level of anti-HBe between the HBV-RNA negative and the positive group. Logistic regression analysis showed that anti-HBc was an independent factor influencing the level of HBV-RNA detection (P = 0.021). Conclusion: HBV-RNA can be detected in some patients with chronic hepatitis B whose serum HBV-DNA level has dropped to undetected levels after ETV treatment. Serum HBV-RNA only comes from the direct transcription of cccDNA, so it is better than HBV-DNA and HBsAg to reflect cccDNA level or activity. Anti-HBc, as an independent factor influencing the level of HBV-RNA, may be used in combination as a new marker to predict the efficacy of antiviral therapy.

[Combined anluohuaxianwan and entecavir treatment significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection].

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman's rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion: Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

Pt nanoparticles decorated heterostructured g-C3N4/Bi2MoO6 microplates with highly enhanced photocatalytic activities under visible light.

Exploring an efficient and photostable heterostructured photocatalyst is a pivotal scientific topic for worldwide energy and environmental concerns. Herein, we reported that Pt decorated g-C3N4/Bi2MoO6 heterostructured composites with enhanced photocatalytic performance under visible light were simply synthesized by one-step hydrothermal method for methylene blue (MB) dye degradation. Results revealed that the synthetic Pt decorated g-C3N4/Bi2MoO6 composites with Bi2MoO6 contents of 20 wt.% (Pt@CN/20%BMO) presented the highest photocatalytic activity, exhibiting 7 and 18 times higher reactivity than the pure g-C3N4 and Bi2MoO6, respectively. Structural analyses showed that Bi2MoO6 microplates were anchored on the wrinkled flower-like g-C3N4 matrix with Pt decoration, leading to a large expansion of specific surface area from 10.79 m2/g for pure Bi2MoO6 to 46.09 m2/g for Pt@CN/20%BMO. In addition, the Pt@CN/20%BMO composites exhibited an improved absorption ability in the visible light region, presenting a promoted photocatalytic MB degradation. Quenching experiments were also conducted to provide solid evidences for the production of hydroxyl radicals (•OH), electrons (e-), holes (h+) and superoxide radicals (•O2-) during dye degradation. The findings in this critical work provide insights into the synthesis of heterostructured photocatalysts with the optimization of band gaps, light response and photocatalytic performance in wastewater remediation.

[The value of the planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of esophageal squamous cell carcinoma].

Objective: The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods: We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results: The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all). Conclusions: The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

[Effective prevention and control of myopia in children and adolescents].

Myopia prevention and control is an important health issue related to children and adolescents, general public physical fitness and national defense security. In 2018, General Secretary Xi Jinping gave instructions on students' myopia. Ministry of Education and other seven ministries and commissions issued the Implementation Plan of the Myopia Prevention and Control for Children and Adolescents. As the myopia prevalence continues to develop into an urgent situation, myopia prevention and control has become a national strategy. In the battle fighting against prevalent myopia, medical and scientific researchers, as professionals, play a key role in guiding the effective implementation of the project and coordinating among five parties including government, schools, medical institutions, families and individual students. It is of great significance to effectively prevent and control myopia for children and adolescents and to achieve the overall goal of prevention and control. This article summarizes the potential effective methods in myopia prevention and control, hoping to provide useful reference and help for the national prevention and control work. (Chin J Ophthalmol, 2019, 55: 81-85).

[Clinical study on microcirculation changes of bulbar conjunctiva after contact lens wear].

Objective: To explore the changes of microcirculation of the bulbar conjunctiva after wearing the contact lens and the relationship between contact lens discomfort and bulbar conjunctiva microcirculation. Methods: Prospective cohort study. The postgraduate students from School of Ophthalmology & Optometry and School of Biomedical Engineering of Wenzhou Medical University were included in this prospective cohort study. The subjects wore soft contact lenses, and the right eye was selected as the experimental eye. The ocular surface disease index (OSDI) questionnaire, Schirmer I and tear break-up time tests were completed before and after wearing the contact lens, and the conjunctival blood flow velocity and microvascular network density were also assessed by using functional slit lamp biomicroscopy. The changes of the indicators after wearing the contact lens were observed and the correlation between the subjective feelings of the wearers and the microcirculation parameters of the bulbar conjunctiva and the main factors affecting the subjective feelings of the wearers were analyzed. Results: Twenty-seven subjects were enrolled in the study, including 8 males and 19 females, aged (22.7±1.6) years. The OSDI score was 11.860± 7.783 before wearing the contact lens and 24.017±12.181 after wearing the contact lens. The comparison before and after wearing the contact lens was statistically significant (t=-4.356, P<0.001). The conjunctival blood flow velocity was (0.534±0.132) mm/s before wearing the contact lens and (0.587±0.134) mm/s after wearing the contact lens. The comparison was statistically significant before and after wearing the lens (t=-2.076, P=0.048). OSDI was positively correlated with blood flow velocity at 1 month after wearing the contact lens (correlation coefficient r=0.383, P=0.048). The test results of the independent variables in the generalized estimating equation model showed that time and blood flow velocity were statistically significant (P<0.05). Conclusions: The blood flow velocity of the bulbar conjunctiva was increased after wearing the contact lens, and the contact lens discomfort of the wearers was positively correlated with the blood flow velocity of the bulbar conjunctiva. (Chin J Ophthalmol, 2019, 55: 98-104).