AIM: To analyze the value of blue-on-yellow perimetry(B/Y)combined with macular ganglion cells inner plexiform layer(GCIPL)detection in the early diagnosis of open angle glaucoma.METHODS: A prospective case-control study was conducted to collect 100 patients(174 eyes)from May 2023 to May 2024 in Eye Hospital of Wenzhou Medical University as the case group, and 20 healthy volunteers(40 eyes)as the control group. The case group was divided into high intraocular pressure group, suspected glaucoma group, and early glaucoma group based on the examination results. All study subjects underwent comprehensive ophthalmic examination, white-on-white perimetry(W/W)and B/Y examination, and swept source optical coherence tomography(SS-OCT)was used to scan the optic disc and macula to obtain relevant parameters. The value of B/Y combined with macular GCIPL in the diagnosis of open angle glaucoma was analyzed.RESULTS: In the case group, 30 cases(52 eyes)were diagnosed with early primary open angle glaucoma, 46 cases(82 eyes)were suspected of open angle glaucoma, and 24 cases(40 eyes)were diagnosed with high intraocular pressure. The W/W mean defect(MD)and B/Y-MD values in the early glaucoma group were lower than those in the control group, high intraocular pressure group, and suspected glaucoma group. The W/W pattern standard deviation(PSD)and B/Y-PSD values were higher than those in the control group, high intraocular pressure group, and suspected glaucoma group(all P<0.05). The W/W-MD and B/Y-MD values in the suspected glaucoma group were lower than those in the control group and the high intraocular pressure group(all P<0.05). The B/Y-MD values in the high intraocular pressure group were lower than those in the control group(P<0.05). The parameters of GCIPL in the macular area of the early glaucoma group were lower than those of the control group, high intraocular pressure group, and suspected glaucoma group(all P<0.05). The minimum GCIPL in the macular area of the suspected glaucoma group, as well as the upper and lower temporal areas, were lower than those of the control group and the high intraocular pressure group(all P<0.05). The average, upper, lower, temporal, 5:00, 6:00, and 12:00 positions of the retinal nerve fiber layer(RNFL)parameters around the optic disc in the early glaucoma group were lower than those in the control group, high intraocular pressure group, and suspected glaucoma group(all P<0.05). The average and upper RNFL parameters in the suspected glaucoma group were lower than those in the control group and high intraocular pressure group. The rim area of the optic nerve head(ONH)parameters in the early glaucoma group was smaller than that in the control group, high intraocular pressure group, and suspected glaucoma group, while the horizontal and vertical cup-to-disc ratio was higher than those in the control group, high intraocular pressure group, and suspected glaucoma group; the rim area of the suspected glaucoma group was smaller than that of the control group and high intraocular pressure group, and the horizontal and vertical cup-to-disc ratio were higher than those of the control group and high intraocular pressure group(all P<0.05). Receiver operating characteristic(ROC)curve was drawn, and the results showed that visual field parameters, macular GCIPL parameters, and RNFL parameters had certain diagnosibility for early open angle glaucoma and suspected glaucoma. Decision curve was drawn, and the results showed that when the threshold was between 0 and 1.0, the net return rate of diagnosing early open angle glaucoma with the combination of B/Y and macular GCIPL parameters was higher than the individual diagnostic efficacy of each indicator.CONCLUSION: The combination of B/Y and macular GCIPL detection can be an important means for the early diagnosis of glaucoma.

AIM: To analyze the changes of retinal structure and function before and after panretinal photocoagulation(PRP)in patients with proliferative diabetic retinopathy(PDR).METHODS: Prospective study. Totally 98 cases(98 eyes)of PDR patients who underwent PRP in Eye Hospital of Wenzhou Medical University from January 2022 to May 2023 were included. Optical coherence tomography angiography(OCTA)was used to detect central retinal thickness(CRT), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), foveal avascular zone(FAZ), deep vascular complex(DVC)blood flow density, superficial vascular complex(SVC)blood flow density before and at 1 wk, 1 and 3 mo after PRP. During the follow-up, 1 eye underwent vitrectomy, 2 eyes were lost to follow-up, and finally 95 eyes completed 1 a follow-up, with a loss rate of 3%. According to the visual prognosis at 1 a after treatment, the patients were divided into two groups: 73 eyes in good prognosis group and 22 eyes in poor prognosis group(including 9 eyes of visual disability and 13 eyes of visual regression). The changes in retinal structure and function before and after PRP treatment were compared between the two groups of patients, and the receiver operating characteristic(ROC)curve and decision curve were used to analyze the predictive value of retinal structure and function for PDR treatment.RESULTS: There were statistical significant differences in PDR staging, CRT, CMT, SFCT, DVC blood flow density, and SVC blood flow density between the two groups of patients before treatment(all P<0.05). At 1 wk, 1 and 3 mo after treatment, the FAZ area of both groups decreased compared to before treatment, while the blood flow density of DVC and SVC increased compared to before treatment(both P<0.05). However, there was no significant difference in the blood flow density of FAZ, DVC, and SVC between the two groups at 1 wk, 1 and 3 mo after treatment(all P>0.05). The CRT, CMT and SFCT of the two groups at 1 wk after treatment were higher than those before treatment(all P<0.05), but there were no significant differences between the two groups(all P>0.05). The CRT, CMT and SFCT at 1 and 3 mo after treatment were lower than those at 1 wk after treatment and before treatment in both groups. The CRT, CMT and SFCT in the poor prognosis group at 3 mo after treatment were higher than those at 1 mo after treatment, and were higher than those in the good prognosis group(all P<0.05). ROC analysis showed that, at 3 mo after laser treatment in PDR patients, the area under the curve of the CRT, CMT, and SFCT alone or in combination after treatment for 1 a was 0.788, 0.781, 0.783, and 0.902, respectively, and the combined prediction value was better(P<0.05). Decision curve analysis showed that the combined detection of CRT, CMT, and SFCT in PDR patients at 3 mo after treatment can improve the predictive value of visual prognosis.CONCLUSION: The optimal time for retinal structure and function recovery in PDR patients after PRP treatment is between 1 wk and 1 mo. OCTA measurement of CRT, CMT, and SFCT at 3 mo after treatment can predict the visual prognosis during the 1 a treatment period.

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Objective:To analyze the clinical characteristics of patients of chronic active Epstein-Barr virus infection (CAEBV) with intestinal involvement misdiagnosed as inflammatory bowel disease (IBD).Methods:A retrospective analysis was conducted on the clinical characteristics, laboratory results, digestive endoscopic findings, histological results, treatment and prognosis of 10 patients with CAEBV intestinal involvement who were misdiagnosed as IBD and treated at the Department of Hematology, Beijing Friendship Hospital, Capital Medical University from February 2019 to November 2022. Epstein-Barr virus-encoded small RNA (EBER) was detected by in situ hybridization. Results:Among the 10 patients with CAEBV, eight were males and two were females. Seven patients had been misdiagnosed as ulcerative colitis and three misdiagnosed as Crohn′s disease. The median age of onset was 36 years (ranged from 26 to 52 years), and the median time from onset to CAEBV diagnosis was 18.5 months (ranged from 2.0 to 96.0 months). The main clinical characteristics of these patients included fever >38.5 ℃ in 10 cases, diarrhea in seven cases, abdominal pain in seven cases, abdominal lymph node enlargement in six cases and hematochezia in seven cases. Six patients primarily presented with gastrointestinal symptoms, and seven patients had involvement of extraintestinal organs, three patients developed hemorrhagic shock due to gastrointestinal bleeding. The laboratory findings included anemia in seven cases, elevated erythrocyte sedimentation rate in six cases, decreased natural killer cell activity in five cases, and elevated ferritin in three cases. Epstein-Barr virus (EBV) DNA were detected in the peripheral blood mononuclear cells (PBMCs) of nine patients, with a median viral load of 23 000 copies/mL. Seven patients were tested positive for anti-EBV viral capsid antigen IgG and nuclear antigen 1 IgG. The main endoscopy findings were hyperemia, edema of the affected intestinal wall mucosa, which could be accompanied by erosion, multiple scattered shallow ulcers with varying sizes. There were six patients with total colon involvement. The rectum was involved in three patients, and the esophagus, gastric antrum, duodenum and small intestine were each involved in one patient. Seven patients underwent follow-up colonoscopy after diagnosis, and four cases progressed. All 10 patients showed active chronic inflammation in the histopathological examinations of their intestinal tissue, with crypt changes in four cases and granulomatous changes in one cases. The intestinal tissues of eight patients were positive for EBER staining, and EBER positive cells≥50 cells/high-power field in seven patients. Seven patients were treated with 5-aminosalicylic acid before the correct diagnosis. Five patients had not improved or progressed upon the follow-up colonoscopy. Two patients died of uncontrolled massive hemorrhage of digestive tract.Conclusions:The clinical, endoscopic and pathological findings of patients with CAEBV intestinal involvement lack specificity. For IBD patients initially diagnosed accompanied by fever and evidence of extraintestinal organ involvement, it is recommended to simultaneously detect EBV DNA in PBMCs and blood plasma, EBER in intestinal tissue, and identify the main EBV-infected cells in peripheral blood and/or tissue, to distinguish CAEBV.

The declining fertility has emerged as a significant concern impacting national welfare, with obesity identified as a major contributing factor. In the hypothalamus, gonadotropin-releasing hormone(GnRH) neurons release GnRH, which regulates the secretion of estrogen and testosterone via the hypothalamic-pituitary-gonadal(HPG) axis, thereby influencing sexual development and fertility. The proper function of GnRH neurons is crucial for maintaining normal sexual development and fertility. Research indicates that obesity can impact GnRH neuron function through several pathways, such as disrupting pulsatile secretion core kisspeptin neurons, causing imbalance in energy sensing and metabolic factor secretion, and triggering hypothalamic inflammation. These pathways directly or indirectly influence GnRH neuron function in the hypothalamus, which ultimately affects sexual development and impairs fertility. Therefore, this review consolidates recent advancements in understanding the mechanisms by which obesity induces dysfunction in hypothalamic GnRH neurons, offering new perspectives for early clinical interventions aimed at enhancing fertility outcomes in obese individuals.

Objective:To explore the differences in genetic variations and clinical features of children with congenital hypothyroidism (CH) with different thyroid morphologies.Methods:A retrospective study was conducted on 98 children with CH diagnosed at Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, and Lianyungang Maternal and Child Health Care Hospital from August 19, 2011, to November 13, 2019. According to thyroid morphology, they were divided into the thyroid dysplasia (TD) group ( n=24), the gland-in-situ (GIS) group ( n=67), and the goiter group ( n=7). Whole exome sequencing was used to detect genetic variants, and pathogenic, likely pathogenic variants, and variants of uncertain significance were defined as potential functional variants. General condition, genetic variants, and treatment were compared between the three groups. Statistical analysis was performed using Chi-square and Bonferroni correction tests, Kruskal-Wallis test, or Mann-Whitney U test. Results:(1) The proportion of female infants in the TD group was higher than that in the GIS and goiter groups [87.5% (21/24) vs.47.8% (32/67) and 3/7, Bonferroni correction, respectively, both P<0.017]. The difference in serum thyroid stimulating hormone levels when diagnosed with CH was statistically significant in the TD, GIS, and goiter groups [128.00 mU/L (33.30-208.00 mU/L), 55.40 mU/L (17.73-116.00 mU/L), and 32.00 mU/L (21.55-57.65 mU/L), H=7.02, P=0.030], but was not statistically significant in pairwise comparisons (all P>0.017). (2) The detection rates of potential functional variants in the TD, GIS, and goiter groups were 45.8% (11/24), 88.1% (59/67), and 6/7, respectively, and the detection rate in the GIS group was higher than that in the TD group (Bonferroni correction, P<0.001). The detection rate of potential functional variants in DUOX2 gene was the highest [59.2% (58/98)], which was 20.8% (5/24), 73.1% (49/67), and 4/7 in the TD, GIS, and goiter groups, respectively, with statistically significant differences between groups ( χ2=20.02, P<0.001). Single allele variants were more common in the TD group (7/11), while double allele variants were more common in the GIS and goiter groups [71.2% (42/59) and 4/6, respectively], in addition, six cases of oligogenic variants were detected in the GIS group (10.2%, 6/59). (3) The difference in the dose of levothyroxine (μg/d) administered to children in the TD, GIS, and goiter groups was statistically significant at 2 years of age [37.50 (25.00-45.00), 25.00 (16.60-25.00), and 25.00 (16.50-40.00), H=16.53] and 3 years of age [37.50 (27.12-47.50), 20.00 (6.25-29.25), and 31.25 (9.38-52.50), H=14.16] (all P<0.001), and the dose of levothyroxine administered in the TD group was higher than that of the GIS group at the age of 2 and 3 years ( Z were -4.06 and -3.75, both P<0.017). Conclusions:The detection rate of underlying functional variants varies among children with CH with different thyroid morphologies. DUOX2 gene variants are the most prevalent and double allele variants are common. Infants and toddlers with TD may require higher doses of levothyroxine as they grow.

Objective:To explore the risk factors and their interation in the incidence of monozygotic twins dur-ing in vitro fertilization-embryo transfer(IVF-ET).Methods:The cohort for this investigation comprised 4537 pa-tients who underwent IVF-ET with single embryo transfer,resulting in live births at Changzhou Maternal and Child Health Care Hospital spanning from January 2011 to December 2021.Among this cohort,76 paitients with monozygotic twins were enrolled in the monozygotic twin group.Employing a 5∶1 propensity score matching strategy,380 patients with monozygotic singletons were enrolled in monozygotic singleton group.Using single fac-tor and Lasso regression analysis to correct for the influencing factors of monozygotic twins,using multiple factor Logistic regression to screen for independent risk factors of monozygotic twins and analyze their impact weights,and then performing multiplication and addition interaction analysis on them.Results:The results of univariate analysis showed that there were statistically significant differences(P＜0.05)between the two groups of patients in terms of age,fertilization method,assisted hatching,embryo type for transfer,embryo transfer method,embryo culture duration,and HCG day estradiol(E2)level.The results of multivariate Logistic regression showed that blas-tocyst transfer(OR 2.847,95％CI 1.559-5.199),frozen-thawed embryo transfer(OR 2.640,95％CI 1.354-5.145),and HCG day E2 level(OR 1.783,95％CI 1.033-3.077)were independent risk factors for monozygotic twins(P＜0.05),demonstrating a hierarchical impact sequence of blastocyst transfer(11.60)＞frozen-thawed embryo transfer(6.54)＞HCG day E2(4.32)level.Notably,there was a significant positive additive interaction between embryo transfer type and HCG day E2 level,with an interaction index(S)of 4.690(95％CI 1.896-11.598),relative excess risk due to interaction(RERI)of 4.128(95％CI 2.236-6.019),and attributable propor-tion due to interaction(AP)of 0.661(95％CI 0.536-0.786).Conclusions:Blastocyst transfer,frozen-thawed embryo transfer,and HCG day E2 level are risk factors for monozygotic twins,and there is a significant positive additive interaction between embryo transfer type and HCG day E2 level.

Objective:To explore the risk factors and their interation in the incidence of monozygotic twins dur-ing in vitro fertilization-embryo transfer(IVF-ET).Methods:The cohort for this investigation comprised 4537 pa-tients who underwent IVF-ET with single embryo transfer,resulting in live births at Changzhou Maternal and Child Health Care Hospital spanning from January 2011 to December 2021.Among this cohort,76 paitients with monozygotic twins were enrolled in the monozygotic twin group.Employing a 5∶1 propensity score matching strategy,380 patients with monozygotic singletons were enrolled in monozygotic singleton group.Using single fac-tor and Lasso regression analysis to correct for the influencing factors of monozygotic twins,using multiple factor Logistic regression to screen for independent risk factors of monozygotic twins and analyze their impact weights,and then performing multiplication and addition interaction analysis on them.Results:The results of univariate analysis showed that there were statistically significant differences(P＜0.05)between the two groups of patients in terms of age,fertilization method,assisted hatching,embryo type for transfer,embryo transfer method,embryo culture duration,and HCG day estradiol(E2)level.The results of multivariate Logistic regression showed that blas-tocyst transfer(OR 2.847,95％CI 1.559-5.199),frozen-thawed embryo transfer(OR 2.640,95％CI 1.354-5.145),and HCG day E2 level(OR 1.783,95％CI 1.033-3.077)were independent risk factors for monozygotic twins(P＜0.05),demonstrating a hierarchical impact sequence of blastocyst transfer(11.60)＞frozen-thawed embryo transfer(6.54)＞HCG day E2(4.32)level.Notably,there was a significant positive additive interaction between embryo transfer type and HCG day E2 level,with an interaction index(S)of 4.690(95％CI 1.896-11.598),relative excess risk due to interaction(RERI)of 4.128(95％CI 2.236-6.019),and attributable propor-tion due to interaction(AP)of 0.661(95％CI 0.536-0.786).Conclusions:Blastocyst transfer,frozen-thawed embryo transfer,and HCG day E2 level are risk factors for monozygotic twins,and there is a significant positive additive interaction between embryo transfer type and HCG day E2 level.

Objective:To explore the risk factors and their interation in the incidence of monozygotic twins dur-ing in vitro fertilization-embryo transfer(IVF-ET).Methods:The cohort for this investigation comprised 4537 pa-tients who underwent IVF-ET with single embryo transfer,resulting in live births at Changzhou Maternal and Child Health Care Hospital spanning from January 2011 to December 2021.Among this cohort,76 paitients with monozygotic twins were enrolled in the monozygotic twin group.Employing a 5∶1 propensity score matching strategy,380 patients with monozygotic singletons were enrolled in monozygotic singleton group.Using single fac-tor and Lasso regression analysis to correct for the influencing factors of monozygotic twins,using multiple factor Logistic regression to screen for independent risk factors of monozygotic twins and analyze their impact weights,and then performing multiplication and addition interaction analysis on them.Results:The results of univariate analysis showed that there were statistically significant differences(P＜0.05)between the two groups of patients in terms of age,fertilization method,assisted hatching,embryo type for transfer,embryo transfer method,embryo culture duration,and HCG day estradiol(E2)level.The results of multivariate Logistic regression showed that blas-tocyst transfer(OR 2.847,95％CI 1.559-5.199),frozen-thawed embryo transfer(OR 2.640,95％CI 1.354-5.145),and HCG day E2 level(OR 1.783,95％CI 1.033-3.077)were independent risk factors for monozygotic twins(P＜0.05),demonstrating a hierarchical impact sequence of blastocyst transfer(11.60)＞frozen-thawed embryo transfer(6.54)＞HCG day E2(4.32)level.Notably,there was a significant positive additive interaction between embryo transfer type and HCG day E2 level,with an interaction index(S)of 4.690(95％CI 1.896-11.598),relative excess risk due to interaction(RERI)of 4.128(95％CI 2.236-6.019),and attributable propor-tion due to interaction(AP)of 0.661(95％CI 0.536-0.786).Conclusions:Blastocyst transfer,frozen-thawed embryo transfer,and HCG day E2 level are risk factors for monozygotic twins,and there is a significant positive additive interaction between embryo transfer type and HCG day E2 level.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.