Objective To evaluate the reliability and validity of the Chinese version of Uncertainty Scale for Kids-22 (USK-22).Methods The Uncertainty Scale for Kids was translated and adapted according to Chinese culture.The reliability and validity of the Chinese version of USK were tested in 117children and adolescents with cancer.Results The rate of recovery was 100％.The rote of effective questionnaire was 95.7％.The patients were easily to understand and it cost them average 8 minutes to finish the questionnaires.Three factors were extracted by factor analysis and could explain 57.043％ of total variance.The correlations between each item and subscale ranged from 0.526 to 0.762.The Cronbach α of USK was 0.872 and the Cronbach α of each subscale ranged from 0.774 to 0.826.The testretest reliability was 0.835.Conclusions The Chinese version of USK is reliable and valid,and can be used to measure the level of uncertainty among Chinese children and adolescents with cancer.

Objective To investigate the clinical application of fast locator in proximal femoral nail antirotation (PFNA) for treating femoral intertrochanter fractures.Methods A retrospective case series study was conducted on the clinical data of 188 patients with femoral intertrochanteric fractures who were treated with closed reduction and PFNA from October 2010 to October 2014.There were 86 males and 102 females,with an average age of 69.5 years (range,55-96 years).Before operation,the patients were divided into two groups according to their will.Group A (98 cases) used the self-made locator to identify the entry point,and Group B (90 cases) used the routine incision operation.The operative preparation time,operation time,fluoroscopy frequency,incision length of major nail,intraoperative blood loss,Harris scores of hip joint function at 4 months after operation,and complications were recorded and compared between the two groups.Results Group A had a longer operative preparation time than Group B[(10.6 ±2.4) minutes vs.(2.5 ±0.9) minutes].However,the operation time [(26.0 ±5.5) minutes vs.(56.6 ± 9.4) minutes],total operation time [(36.6 ± 6.6) minutes vs.(59.6 ± 9.9) minutes],fluoroscopy frequency [(18.9 ± 5.1) times vs.(31.2 ± 9.1) times],blood loss [(50.5 ± 3.7) ml vs.(220.5 ± 2.7) ml] and incision length of major nail [(2.5 ± O.7) cm vs.(5.5 ± 1.7) cm] in Group A were all less than those in Group B (P ＜ 0.05).There was no significant difference in the excellent and good rate of Harris score at 4 months after operation between the two groups (97％ vs.97％) (P ＞0.05).Postoperative incision infection,hypostatic pneumonia,and deep vein thrombosis occurred in some patients.No significant difference in the incidence rates of complications in two groups (14％ vs.10％) was found (P ＞ 0.05).Conclusion Femoral nail needle point locator can quickly identify the entry point,improve the nail placement accuracy and reduce surgical trauma as well as shorten operation time,and hence is worthy of clinical application in the treatment of femoral intertrochanteric fractures.

Objective:To observe the incidence and risk factors of microcystic macular edema (MME) in patients with idiopathic macular epiretinal membrane (IMEM) preoperatively and postoperatively.Methods:A retrospective case series study. From January 2017 to May 2021, 72 eyes of 72 patients with IMEM in Eye Hospital of Wenzhou Medical University at Hangzhou were included. There were 18 male and 54 female. Average age was 64.8±7.8 years. Eyes were all monocular. All patients received the examination of best corrected visual acuity (BCVA) by standard logarithmic visual acuity chart, which was represented logarithmic of minimum angle of resolution (logMAR). Optical coherence tomography was used to measure central macular thickness (CMT). MME was defined as small, vertically bounded cystic space located outside the fovea in the inner layer of the retina. According to the presence or absence of MME before surgery, the affected eyes were divided into two groups: non-MME group (35 eyes) and MME group (37 eyes). The difference of logMAR BCVA and CMT was statistically significant between Group A and B ( t=3.117, 2.589; P=0.003, 0.012). All patients with IMEM were treated with 23G three-channels pars plana vitrectomy (PPV) with epiretinal membrane and inner limiting membrane (ILM) peeling. The two groups were further divided into four groups according to whether there was MME in the postoperative follow-up time. The group A1 was without MME before and after surgery, group A2 was without MME before surgery and with MME after surgery. The MME group was subdivided into the group with MME before surgery and without MME after surgery (group B1) and the group with MME before and after surgery (group B2). The mean follow-up time was 8.8±7.7 months. The same equipment and methods were used to exam the patients during the follow-up. Paired t test was used to compare the changes of MME, BCVA and CMT before and after surgery. The differences of CMT and BCVA among groups before and after surgery were compared by independent sample t test and one-way ANOVA. Logistic regression was used to analyze the influencing factors of MME before and after surgery, and multiple linear regression was used to analyze the influencing factors of postoperative BCVA. Results:There were 35 eyes in the non-MME group, 18 eyes (51.43%, 18/35) in the A1 group and 17 eyes (48.57%, 17/35) in the A2 group, respectively. There were 37 eyes in MME group, 6 eyes (16.22%, 6/37) in group B1 and 31 eyes (83.78%, 31/37) in group B2, respectively. At last follow-up, the logMAR BCVA was 0.10±0.12, 0.25±0.17, 0.09±0.11, 0.30±0.26 in group A1, A2, B1, and B2, respectively. Compared with the logMAR BCVA before surgery, the differences were statistically significant ( t=3.779, 4.253, 7.869, 6.668; P<0.01). There was significant difference in logMAR BCVA among the four groups ( F=4.460, P<0.01). There was a significant difference in logMAR BCVA between group A1 and group A2 ( t=-2.930, P=0.006). There was no significant difference between group B1 and group B2 ( t=-1.921, P=0.063). The CMT of group A1, A2, B1 and B2 were 371.83±73.24, 431.24±83.13, 407.00±28.07 and 425.19±70.97 μm, respectively. Compared with those before operation, the differences were statistically significant ( t=5.197, 2.465, 3.055, 6.078; P<0.05). There was no significant difference in CMT among the four groups ( F=2.597, P=0.059). Logistic regression analysis showed that pre-operation MME was correlated with pre-operation IMEM stage ( β=1.494, P=0.004). New MME after surgery was correlated with age ( β=0.153, P=0.013). Multiple linear regression analysis showed that postoperative visual acuity was significantly correlated with CMT before surgery and MME after surgery ( β=0.001, 0.134; P=0.015, 0.019). Conclusions:PPV combined with epiretinal membrane and ILM peeling surgery for IMEM can improve visual acuity and decrease CMT. MME regress or regenerate after surgery. Age is an independent predictor of the risk of newly formed MME after surgery.

Objective:To explore the positive rate of scanning laser ophthalmoscope in the retromode (RM-SLO) in different types of diabetic macular edema (DME), and to analyze its correlation with foveal thickness (CMT) and macular volume.Methods:From March to May 2021, 40 patients (65 eyes) were diagnosed as DME by fundus examination combined with optical coherence tomography (OCT) in Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. All eyes underwent best corrected visual acuity (BCVA), OCT and RM-SLO fundus imaging examinations, 47 eyes underwent fluorescein fundus angiography (FFA) examination. RM-SLO fundus imaging examinations were performed with Mirante SLO, including retro mode illumination deviated right (RMDR) and retro mode illumination deviated left (RMDL). If one or more of the RMDR and RMDL of the examined patient can identify macular edema, RM-SLO was considered to be able to identify macular edema. The macular volume at CMT and 6 mm from the fovea was measured by OCT software. DME were divided into 3 types based on OCT images: diffuse retinal thinkening (DRT) type; cystoid macular edema(CME) type; serous retinal detachment (SRD) type, focal leakage type, diffuse leakage type and diffuse cystic leakage type. The consistency of RMDR and RMDL in the diagnosis of DME in RM-SLO fundus imaging was evaluated, as well as their positive rate in different classifications of DME. The correlation between the detection of macular edema by RM-SLO and the DME type, CMT and foveal volume, and the correlation between BCVA and edema type, CMT and macular volume were analyzed.Results:Among 65 eyes, the positive rates of RMDR and RMDL fundus imaging to detect DME were 46 (70.77%, 46/65) and 48 (73.85%, 48/65), respectively. There was good consistency in identifying DME (Kappa value=0.770; P<0.001). The positive rates of RMDR and RMDL fundus imaging DRT, CME and SRD type of DME were 42.11% (8/19), 57.89% (11/19), 77.78% (28/36), 77.78% (28/36), 100.00% (10/10), 90.00% (9/10), respectively. In the FFA classification of them, the positive rates of focal leakage, diffuse leakage and diffuse cystic leakage were 68.75% (11/16), 62.50% (10/16), 68.00% (17/25), 76.00% (19/25), 100.00% (6/6), 100.00% (6/6), respectively. The results of Spearman correlation analysis showed that whether RM-SLO could identify DME was associated with CMT and OCT classification ( r=0.310, 0.365; P=0.120, 0.003); there was no correlation between FFA classification and macular volume ( r=0.113, 0.117; P=0.449, 0.352). BCVA was correlated with CMT and macular volume ( r=0.307, 0.269; P=0.013, 0.030), however, there was no significant correlation with OCT type, angiographic type ( r=0.051, 0.175; P=0.684, 0.240). Conclusion:The diagnostic agreement of DME are good between RMDR, RMDL of RM-SLO image. DME of DRT type and patients with smaller CMT in OCT are difficult to identified by RM-SLO fundus imaging.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.