Background Evidence-based medicine (EBM) has been widely applied to solve clinical issues internationally,however,the awareness of oculists in China still is dissatisfied,and the relevant issue survey can offer the training guidance.Objective This study was to survey the status of the cognition and practice of EBM in ophthalmologists in China and analyze the problems in their EBM practice.Methods Two hundred and thirty-three ophthalmologists were enrolled in the 18th Congress of Chinese Ophthalmological Society in August,2013.A survey about EBM was performed by self-made questionnaire,including general data from the surveyors,the way and channel of understanding EBM,the attitude toward EBM,clinical practice of EBM and influencing factors.The educational background,professional qualifications,ranked distribution of hospitals which surveyors came from,size of the citys and attribute of hospitals were stratified and analyzed.SPSS 17.0 software was used for statistical analysis.Results A total of 233 questionnaires were distributed,and 233 were regained with the response rate 100％,and 214 valid questionnaires were included,with the effective rate 91.8％.50.5％ of the respondents (104/206) knew EBM in university.The proportion of those believe EBM initially as medical students was 41.8％,and 49.1％ (102/208) were aware of EBM in recent 8 years.And 47.7％ (101/211) believed that EBM should be given priority in clinic,and 7.5％ (16/211) were indifferent to EBM.Only 3.8％ (8/211) surveyors thought EBM to be little important.The proportion of the respondents choosing ‘ know’ or ‘ moderately-know’ were 69.1％ (148/214),35.0％ (75/ 213),21.5％ (46/213) and 57.4％ (121/211) respectively in EBM,Meta analysis,Cochrane as well as Preferred Practice Patterns (PPPs) with a higher receiving degree in well-educated individuals (P =0.000,0.000,0.001,0.000).EBM was well practiced in 11.7％ (25/211) oculists,with a higher using frequency in senior ophthalmologists,and 17.8％ (89/495,frequency) oculists consulted the EBM literature to resolve problems in clinic,with a significant difference in the using frequency of EBM among the different educational background subjects (x2=13.406,P=0.037).The top three barriers which affected the application of EBM in clinical practices were lack of time and the limited energy,feeling it difficult to evaluate the evidence correctly as well as the absence of cases proving the efficacy to treat based EBM.The type of EBM evidence mostly used by respondents was medical database (36.7％),and CNKI (33.5％) and PubMed (38.4％) were the mostly used Chinese and English database,respectively.Respondents who have never searched the Chinese or English database occupied up to 7.3％ and 17.2％,respectively.Conclusions The cognition degree and applying frequency are still lower in ophthalmologists in China.The training of EBM should be strengthened in medical students.The guidance measurement should be taken to encourage eye doctors to apply EBM.

Objective To investigate MR findings and analysis of misdiagnosis of atypical invasive pituitary adenoma.Methods The MR findings of twenty cases of atypical invasive pituity adenomas confirmed by pathology were reviewed ,which were misdiag-nosed as chordomas or meningiomas.Results All the twenty cases showed iso-or slightly hypo-signal on T1 WI,iso-or slightly hy-per-signal on T2 WI;Enhanced scan displayed heterogeneous enhancement.The dynamic enhancement curve showed rapid enhance-ment phase.The bilateral cavernous sinuswere infringed in nine cases,in which the pituity and pituity stalk were not well seen. Among the twenty cases,twelve cases with suprasellar and anterior cranial fossa extension were misdiagnosed as meningiomas;eight cases with clival destruction were misdiagnosed as chordomas.Conclusion The MR features of atypical invasive pituity adenomas are various.In order to avoid misdiagnosis,a comprehensive analysis should be based on a variety of signs.

Objective To observe the value of diffusion-weighted imaging (DWI)and ADC value in the differential diagnosis of benign and malignant lesions of the tongue.Methods 75 patients with lingual lesions,including 32 benign lesions and 43 malignant tumors,underwent conventional MRI,contrast-enhanced MRI and DWI with b values of 0 and 1 000 s/mm2 before therapy.ADC maps were reconstructed,and the ADC values of the lingual lesions were calculated.Diagnostic performance of ADC was compared using receiver operating characteristic curves (ROC).Results The mean ADC values of benign lesions and malignant tumors were (1.84±0.47)×10 -3 mm2/s and (1.12±0.21)×10 -3 mm2/s,respectively.Malignant tumors had lower ADCs than benign lesions (t=-8.038,P <0.000).The areas under the ROC curves of ADC diagnosing benign and malignant lesions of the tongue was 0.957±0.022.The optimal cutoff values of ADC for differentiating benign and malignant lesions of the tongue was 1.30 × 10 -3 mm2/s with sensitivity of 90.7%,specificity of 93.8% and accuracy of 92%.And ADC had a high consistency compared with pathological results (Kappa values were 0.813).Conclusion Different features between benign and malignant lesions of the tongue are able to be identified with DWI,which can be applied as a complementary tool in the detection of benign and malignant lesions of the tongue.

Objective To evaluate the utility of susceptibility weighted imaging (SWI)in the evaluation of traumatic brain injury (TBI)severities.Methods 20 mild TBI patients,20 moderate TBI patients and 20 severe TBI patients were collected.The involving brain regions,numbers and areas of hemorrhagic lesions detected by SWI were analyzed and the differences of each group were com-pared.The correlation analysis between Glasgow coma scale(GCS)scores and each above parameters were underwent.Results The differences of involving regions’number,lesions’number,lesions’area were statistically significant(P <0.05 ).Severe TBI group got the maximum number of involving regions,lesions,and the largest areas,followed by moderate group and mild group.The GCS were highly negatively correlated with the number of involving regions,number of lesions,areas of lesions detected by SWI.In descending order of relevance:GCS with areas detected by SWI(r=-0.982,P=0.000),the number of lesions detected by SWI(r=-0.941,P=0.000),the number of involving regions detected by SWI(r=-0.900,P=0.000).Conclusion The clinical applications of SWI in diagnosing TBI and evalua-ting the TBI severity is of great significance.

Background Preferred practice pattern (PPP) is an evidence-based documents which can be used for reference to standardize medical practice by ophthalmologists.So far it has been promoted for more than 10 years in China.However,there is no report about the popularization and application of PPP in China.Objective This study was to investigate the cognitions of ophthalmologists to PPP from the view of clinical questions.Methods A questionnaire-based study was conducted.Questionnaires were dispensed during September 17 to 21,2014 to inquiry into the cognitions of ophthalmologists to PPP in the 19th Congress of Chinese Ophthalmological Society.A selfadministered questionnaire was designed and discussed according to the article published in the past by our research group.It included personal basic information and cognitions to PPP,and the latter consisted of self-assessment and cognition scoring.The constituent ratios of aware,quite aware,unaware and fully unaware ophthalmologists were counted.The cognitions were divided into low level (0-4 scores),moderate level (5-8 scores) and high level (9-12 scores) based on the effective answer sheets.The questionnaires were filled out anonymously and incomplete questionnaires were excluded.Results Among the 300 distributed questionnaires,282 were retrieved and 209 were valid,with the effective rate 74.1％.The ophthalmologists of awareness to PPP were 46.4％ (97/209),and 53.6％ (112/209) of respondents did not know PPP very well.A positive correlation was found between the awareness to PPP and the cognition scores to clinical issues (r,=0.143,P ＜ 0.05).The cognition scores to clinical issues were significantly different among different educational backgrounds (F =12.26,P ＜ 0.05),and cognition scores were significantly reduced in the ophthalmologists with lower master degree in comparison with the ophthalmologists with doctoral degree (all at P＜0.05).The coincide ratio between cognitions of ophthalmologists to different clinical issues and suggestions in PPP were evidently different in the ophthalmologists,with the highest coincide ratio 83％ and the lowest coincide ratio 1％.Conclusions The awareness to PPP is not adequate in Chinese eye doctors,which reduces the cognition level to clinical issues.There is a poor coincide ratio between cognitions of Chinese ophthalmologists to clinical issues and suggestions in PPP.This study emphasizes the need for effective awareness programs towards clinical issues based on PPP.

Objective To study the effect of TLR4 activation with LPS on BMP9-induced osteogenic differentiation of immortalized mouse embryonic fibroblasts ( iMEFs).Methods The activation of TLR4/NF-κB signaling path-way was detected by ICC.iMEFs were treated with LPS,BAY11-7082,Adnovirus GFP and BMP9.The early osteo-genic differentiation capability of iMEFs was detected by ALP staining and quantitative assay .The later osteogenic differentiation capability was detected by alizarin red S staining .The expression of later osteogenic differentiation marker gene OCN and OPN were detected by PCR and Western blot .The change of p-Smad1/5/8 was detected by Western blot.The expression of Runx2 and Dlx5 were detected by PCR and Western blot .Results LPS can effec-tively stimulate TLR4/NF-κB signaling pathway .TLR4 activation inhibited BMP 9-induced osteogenic differentiation . BMP9-induced osteogenic differentiation related gene and Smad 1/5/8 signaling activation were inhibited by TLR4 activation .The inhibition effect was partly reversed by BAY 11-7082 ( P<0.05 ) .Conclusions TLR4 activation with LPS can inhibit BMP9-induced osteogenic differentiation of iMEFs cells via NF-κB signaling pathway .

Objective To investigate the application value of apparent diffusion coefficient (ADC) in monitoring the response to chemotherapy of primary bone lymphoma(PBL). Methods Sixteen consecutive patients with PBL confirmed by pathology were enrolled in this retrospective study.All patients underwent a controlled MRI including a DWI sequence before chemotherapy and after the first chemotherapy session. The ADC values of PBL lesions were measured before and after the first chemotherapy session. All patients were divided into responders and non-responders groups according to the combined response assessment criteria. The difference in ADC values between the responders and non-responders groups before and after chemotherapy and the rate of change of ADC values were compared using Wilcoxon test. The paired t test was used to compare ADC values before and after chemotherapy in each group. Results Twenty-three cases of PBL lesions were diagnosed in 16 patients before the chemotherapy. After the first chemotherapy session, 10 patients (12 lesions) and 6 patients (11 lesions) were categorized into the responder and non-responder group, respectively. The mean pre-treatment ADC value of the responder group and non-responder group were 737.1(301.7,928.4)× 10-6mm2/s and 749.2(624.4, 1186.5)× 10-6mm2/s, which had no statistically significant difference (Z=1.51,P=0.132). The mean post-treatment ADC value of the responder group and non-responder group were 1843.0(721.5,2745.8)× 10-6mm2/s and 1026.3(382.8,2100.8)× 10-6mm2/s, which had no statistically significant difference (Z=-1.75,P=0.079). The post-treatment ADC value of the responder group significantly increased [156.7(60.9,227.5)%] while the post-treatment ADC value of the non-responder group slightly increased [31.7(-44.7,147.4)%]. The difference in the percentage changes of ADC values in the responder and non-responder groups before and after the treatment was statistically significant(Z=-3.66,P<0.001). Conclusion The measurement of the percentage changes of ADC values enable a good short-term response evaluation for PBL.

Objective: To explore the effectiveness of the comprehensive intervention on prevention of deciduous primary caries in 3-year-old children, so as so provide reference for the prevention, health care and treatment of oral caries. Methods: Three-year-old children selected by drawing lots from 10 public kindergartens in 5 districts of Bengbu were examined in 2021, and were randomly divided into intervention group ( n =300) and control group ( n =300). During the initial examination, caries loss (dmf) including dental caries, missing teeth, filling teeth were assessed in the two groups. At the initial examination, the intervention group received caries intervention while no intervention was administered in the non-intervention group until half a year later. Intervention measures included education, diet, self-cleaning and fluoride application intervention. The number of cases and the mean of caries loss in the two groups were compared by χ 2 test. Results: Before the intervention, 43 children in the control group suffered from caries, with 88 dmf, including 44 dmf for boys and 44 dmf for girls. There were 45 children in the intervention group, with 101 dmf, including 49 dmf for boys and 52 dmf for girls. There was no significant difference in the number of dmf between the intervention group and the control group ( χ 2=0.91, P >0.05), and there was no significant difference in the prevalence rate (15.0%, 14.3%, χ 2=0.05, P >0.05). After the intervention, there were 26 new dental caries and 43 dmf in intervention group, including 25 dmf for boys and 18 dmf for girls. In the control group, there were 83 new dental caries and 168 dmf, including 72 dmf for boys and 96 dmf for girls. Compared with the control group, the new dmf in the intervention group was significantly different ( χ 2=75.38, P < 0.05). The number of new dental caries patients in the intervention group was significantly different from that in the control group ( χ 2=36.42, P <0.05). Conclusion Comprehensive interventions to prevent dental caries can significantly reduce the incidence of primary teeth caries in children. It is suggested to intervene dental caries as early as possible to reduce the incidence of dental caries and other oral diseases.

Objective To analyze the MRI features of endometrial stromal sarcoma(ESS)and to explore its value in clinical application. Methods Thirteen patients with histologically proven ESS were collected.All cases underwent non-contrast MRI scan and DWI,10 of which underwent contrast-enhanced MRI scan.The MRI features were discussed in combination with the pathological results after operation.Results In all lesions,6 lesions were located in endometrial cavity,4 in myometrium,1 in right wall of uterus and broad ligament,1 in cervical canals,and 1 in the top segment of vagina and pelvic.Plain MRI showed the lesions with hypointensity on T 1 WI and mixed hyperintensity on T 2 WI,which exhibited polypoid or multiple nodular masses.DWI showed the lesions with different hyperintensity.In 10 patients with post-enhanced scanning,moderate or marked heterogeneous enhancement of the masses were demonstrated,in which 6 presented plateau pattern of time-signal enhanced curve and 4 were persistent pattern.Conclusion ESS had some characteristic features on MRI,and DWI and dynamic contrast-enhanced examination can help to improve the diagnosis and differential diagnosis.

Background It has been reported that orthokeratology has the effects of slowing down myopia progression and axial elongation.However,the affecting mechanism of orthokeratology wearing on ocular peripheral refraction is still not elucidated.Objective This study was to observe and compare the changes of ocular peripheral refraction and relative peripheral refraction (RPR) in low to moderate myopic eyes of children after wearing orthokeratology lens and spectacles for 6 months.Methods A randomized controlled clinical trial was carried out after approval of Ethic Committee of Beijing Tongren Hospital and informed consent of guardians of the children.One hundred myopic children aged (ll.0±1.9) years were recruited in Beijing Tongren Hospital from June 2014 to January 2015,with the diopter of-0.50 to-6.00 D.The subjects were randomized into orthokeratology group and spectacles group by the process PLAN PROC of software SAS 9.1.3,50 for each group.The subjects in the orthokeratology group wore orthokeratology lens for 6 months and those in the spectacles group wore spectacles for the same period.An infrared open-field autorefractor was employed to measure the refraction at central 0°,temporal 15°,temporal 30°,nasal 15°and nasal 30° radial lines before and after wearing lens for the assessment and comparison of the changes of peripheral refraction and RPR.Results There was no significant difference in spherical equivalent between the orthokeratology group and the spectacles group before wearing lens ([-3.35±1.31] D versus [-3.01± 1.15] D,P =0.20).The peripheral refraction values in the orthokeratology group were (-2.28 ± 1.60),(-3.28±1.41),(-3.40±1.23),(-3.38±1.12) and (-2.09±1.29)D at nasal 15°and nasal30°,central,temporal 15° and temporal 30°radial lines before wearing lens,and reduced by (0.29±1.67),(0.85±1.66),(0.92±1.76) and (0.66±1.66) D at nasal 30°,nasal 15°,central and temporal 15° after wearing lens,respectively,with significant differences at nasal 15°,central and temporal 15°(all at P＜0.05).The peripheral refraction values in the spectacles group were (-1.88±1.30),(-2.66±1.18),(-2.89±1.27) and (-1.94±1.31)D at nasal 15°,nasal 30°,temporal 15 ° and temporal 30°,radial lines before wearing lens and increased by (-0.25±0.80),(-0.43 ±0.67),(-0.32±0.64) and (-0.22±0.75)D after wearing lens,respectively,with significant differences between before and after wearing lens (all at P＜0.05).The RPR shifted from hyperopia defocus to myopia defocus before and after wearing lens in temporal 15° and 30° radial lines in the orthokeratology group,and at various radial lines in the spectacles group,the RPR showed gradually worsening of hyperopia defocus.Conclusions Long-term wearing of orthokeratology results in a hyperopia shifting in myopic children by exposing the peripheral retina towards relative myopia defocus,whereas wearing spectacles leads to a relative hyperopia defocus on retina.Thus,orthokeratology may slow down the myopia progression.