AIM: To compare the efficacy, safety, and complications of 27G and 25G vitrectomy in the treatment of rhegmatogenous retinal detachment(RRD)involving the macular area.METHODS:This retrospective study analyzed 60 patients(60 eyes)initially diagnosed with RRD involving the macular area and undergoing 25G or 27G vitrectomy combined with retinal reattachment at our hospital from January 2021 to December 2023. Patients were divided into 25G group(30 eyes)and 27G group(30 eyes). Best corrected visual acuity(BCVA), intraocular pressure(IOP), surgical duration, retinal reattachment rate and complications of both groups of patients were compared before and after surgery.RESULTS: The mean surgical time in the 27G group was slightly longer than in the 25G group(40.20±7.52 vs 36.97±7.47 min). Incision leakage occurred in 7 eyes(23%)in the 25G group versus 1 eye(3%)in the 27G group, though the difference was not statistically significant between two groups(P>0.05). At 6 mo postoperatively, BCVA(LogMAR)improved significantly in both groups(27G: 0.37±0.19 vs preoperative 0.98±0.32; 25G: 0.40±0.17 vs preoperative 0.84±0.33; all P<0.05), with no statistical difference in BCVA(P>0.05). At 1 d postoperatively, the 25G group had lower mean IOP(12.29±2.86 mmHg)compared to the 27G group(15.87±3.70 mmHg; P<0.001), but no differences were observed at 1 wk or 1 mo postoperatively(all P>0.05). Retinal reattachment rates and complications(intra- or postoperative)showed no significant intergroup differences(all P>0.05).CONCLUSION: Both 25G and 27G vitrectomy are safe and effective in treating rhegmatogenous retinal detachment. However, the 27G vitrectomy offers advantages such as small incisions, better self-sealing properties, and more stable IOP.

Objective To compare the cost-utility of tislelizumab and sorafenib in the first-line treatment of advanced unresectable hepatocellular carcinoma,and to provide a reference for the selection of treatment regimens from the perspective of pharmacoeconomics.Methods A partitioned survival model was used to simulate the survival status of patients using tislelizumab or sorafenib within 10 years,and the cost and health output were calculated respectively to obtain the incremental cost-utility ratio(ICUR).The 3 times China's per capita gross domestic product(GDP)in 2022 was taken as the threshold for willingness to pay(WTP).Results During the simulation period,the ICER of tislelizumab versus sorafenib was 280 691.4 yuan/quality-adjusted life year(QALY),which was significantly higher than that of the sorafenib group,which had obvious economic performance.Univariate sensitivity analysis showed that the incidence of grade 3 or above adverse reactions in the tislelizumab group,the cost of tislelizumab,and the incidence of grade 3 or higher adverse reactions in the sorafenib group were important factors affecting ICUR.Probabilistic sensitivity analysis showed that tislelizumab had a significant cost-utility advantage when WTP was 3 times GDP,with an economic probability of 81.4％,and the results were robust.Conclusion For the first-line treatment of advanced unresectable hepatocellular carcinoma,tislelizumab has a significant cost-utility advantage over sorafenib.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Non-alcoholic fatty liver disease （NAFLD） is a chronic liver disease with complex and diverse pathogenesis， and there is no effective treatment or specific drugs for its clinical treatment. In recent years， its incidence has been on the rise， and it has become the earnest expectation of medical researchers in China and abroad that related patients could be treated. AMP-activated protein kinase （AMPK） functions to regulate cellular energy homeostasis and mitochondrial homeostasis. When activated， it has a good intervention effect on NAFLD progression with lipid metabolism disorders and mitochondrial homeostasis disorders. For NAFLD， the activation of AMPK can inhibit the production of new lipogenesis in the liver， promote the oxidation of fatty acids in the liver， and enhance the mitochondrial function of adipose tissues. As a key target of metabolic diseases， AMPK can also improve apoptosis， liver fibrosis， autophagy， and inflammation. Traditional Chinese medicine （TCM） is good at treating diseases from multiple targets and multiple pathways and is also commonly used in the treatment of chronic liver disease in clinical practice. A large number of in vitro and in vivo experimental studies on NAFLD have shown that TCM monomers have good prospects for the treatment of NAFLD through the AMPK signaling pathway， including glycosides， phenols， alkaloids， flavonoids， quinones， terpenoids， and lignans， which are natural activators of AMPK. This study reviewed the research progress on TCM monomers in regulating the AMPK pathway to prevent and treat NAFLD， providing a broader perspective for TCM treatment of NAFLD.

BACKGROUND: Lung cancer is the main cause of cancer-related death globally. Single nucleotide polymorphism (SNP) is one of the important factors leading to the occurrence of lung cancer, but its mechanism has not been elucidated. This study intends to investigate the relationship between SNPs of CDH1, FANCB, APC genes and lung cancer genetic susceptibility. METHODS: The case-control study design was used. We collected blood samples from 270 lung cancer cases in the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, as well as blood samples from 445 healthy volunteers as controls, and extracted genomic DNA for genotyping using the Taqman® SNP genotyping kit. The distribution of three SNP loci of CDH1 gene rs201141645, FANCB gene rs754552650 and APC gene rs149353082 in Chinese population was analyzed. Chi-square test and Logistic regression were used to analyze the relationship between different genotypes and the risk of lung cancer. RESULTS: The distribution frequencies of AA, A/G and GG genotypes at rs754552650 of FANCB gene in the control group were 27.2%, 52.6% and 20.2%, respectively. The distribution frequencies of AA and A/G genotypes were 93.7% and 6.3% in the case group, respectively, and no GG genotype was detected. The A/G genotype of the rs754552650 locus of the FANCB gene was significantly different between the case group and the control group. Compared with the carriers of AA genotype, the individuals with FANCB rs754552650 A/G genotype had a lower risk of lung cancer (OR=0.035, 95%CI: 0.020-0.062, P<0.001). CDH1 gene rs201141645 A/C and CC genotypes only existed in the control group. In addition, only 1 sample was found to have APC rs149353082 genotype in the case group. CONCLUSIONS In the Chinese population, the lung cancer risk of the individuals with FANCB rs754552650 A/G genotype was significantly decreased.
Antigens, CD/genetics* ; Cadherins/genetics* ; Case-Control Studies ; China ; Fanconi Anemia Complementation Group Proteins/genetics* ; Gene Frequency ; Genes, APC ; Genetic Predisposition to Disease ; Genotype ; Humans ; Lung Neoplasms/genetics* ; Polymorphism, Single Nucleotide

Objective:To investigate the inhibitory effect of RMT1-10-induced tolerogenic dendritic cells (Tol-DCs) in vitro on high-risk corneal allograft rejection in mice and its mechanism. Methods:One hundred SPF male BALB/c mice and fifty SPF male C57BL/6 mice were selected.Bone marrow-derived immature dendritic cells (imDCs) obtained from C57BL/6 mice were divided into imDCs group, mature dentritic cells (mDCs) group, RMT1-10 group, and IgG isotype control group.The imDCs in the four groups were cultured with no intervention, lipopolysaccharide, RMT1-10 and lipopolysaccharide, or IgG isotype antibody and lipopolysaccharide for 7 days according to grouping.The expression levels of different phenotypes of DCs including CD11c, CD80, CD86, major histocompatibility complex (MHC)-Ⅱ, T cell immunoglobulin and mucin domain containing molecule (Tim)-4 and CD103 in the four groups were detected by flow cytometry.The concentrations of interleukin-10 (IL-10) and transforming growth factor-β (TGF-β) in the DCs supernatants were determined by enzyme-linked immunosorbent assay.A mixed lymphocyte culture system was established, and the stimulation index (SI) of CD4 + T cell proliferation stimulated with DCs was detected by cell counting kit 8 method.Corneal neovascularization was induced by corneal stromal suture in BALB/c mice, and the 80 mice with neovascularization in 4 quadrants growing into the middle and peripheral cornea were used as recipients.The recipient mice were randomized into imDCs group, mDCs group, RMT1-10 group, and IgG isotype control group using the random number table method, with 20 mice in each group.An injection of corresponding DCs (1×10 6 cells/100 μl) was administered to the recipient mice via the tail vein according to grouping.At 7 days following the injection, C57BL/6 mice were used as donors and penetrating keratoplasty was performed.Within one month after the operation, signs of corneal grafts rejection, including opacity, edema and neovascularization, were observed by slit lamp biomicroscopy and scored every day.At 21 days after the operation, 5 recipients selected from each group were subcutaneously injected with naive C57BL/6 splenocytes (1×10 6 cells/100 μl) behind the ear.The delayed type hypersensitivity (DTH) was evaluated by ear swelling at 24 hours after the subcutaneous injection.The use and care of experimental animals complied with the Regulations on the Management of Experimental Animals promulgated by the State Science and Technology Commission.This study protocol was approved by an Ethics Committee of the Affiliated Hospital of Chengde Medical University (No.CYFYLL2020055). Results:Compared with mDCs group, the expressions of CD80, CD86 and MHC-Ⅱ, and the percentage of Tim-4-positive cells in CD11c-positive cells were significantly decreased in RMT1-10 group, showing statistically significant differences (all at P<0.001). The percentage of Tim-4-positive cells were significantly decreased in RMT1-10 group than imDCs group, and the percentage of CD103-positive cells in RMT1-10 group was significantly higher than imDCs group, mDCs group and IgG isotype control group (all at P<0.001). The concentrations of IL-10 and TGF-β in the cell culture supernatant of RMT1-10 group were significantly higher than those of the other three groups, with statistically significant differences (all at P<0.001). There were statistically significant differences in the SI of CD4 + T cell proliferation simulated by DCs ( Fgroup=1 833.00, P<0.001; Fratio=230.40, P<0.001; Finteraction=3.06, P=0.01). The SI of DCs/CD4 + T cells ratio at 1∶5, 1∶10, 1∶20 and 1∶40 were all significantly lower in imDCs group than mDCs group, and were all significantly lower in RMT1-10 group than imDCs group (all at P<0.05). There was a statistically significant difference in corneal graft survival curve among various groups ( χ2=77.69, P<0.001). The survival rate of RMT1-10 group was significantly higher than that of imDCs group ( χ2=9.74, P=0.002), and the survival rate of imDCs group was significantly higher than that of mDCs group ( χ2=31.02, P<0.001). The ear swelling of recipient mice of positive control group, mDCs group, IgG isotype control group, imDCs group and RMT1-10 group was (503.6±17.2), (475.7±17.6), (456.2±18.8), (225.2±39.4), (118.1±12.6), and (106.4±7.4) μm, with a statistically significant difference among them ( F=377.10, P<0.001). The mice ear swelling was more serious in positive control group than mDCs group, more serious in IgG isotype control group than imDCs group, and more serious in imDCs group than RMT1-10 group (all at P<0.05). Conclusions:RMT1-10 can inhibit the rejection of high-risk corneal transplantation in mice, the mechanism of which may be attributed to inducing imDCs to transform into Tol-DCs in vitro and up-regulating the expression of TGF-β and IL-10, which promotes antigen-specific immune tolerance after adoptive transfer, thereby indirectly prolongs the survival of corneal grafts.

Objective:To observe the characteristics of choroidal thickness in patients with macular edema secondary to superior temporal branch retinal vein occlusion (BRVO-ME).Methods:A retrospective control study. From November 2020 to September 2021, 30 patients (30 eyes) with BRVO-ME (BRVO-ME group) were diagnosed by ophthalmology examination in Department of Ophthalmology, The Affiliated Hospital of Chengde Medical College and 14 healthy volunteers (28 eyes) were enrolled in the study. The choroidal thickness of macular area was measured by enhanced deep imaging technique of frequency domain optical coherence tomography. According to the subdivision of the diabetic retinopathy treatment group, the choroid within the 6 mm of the macular fovea was divided into three concentric circles with the macular fovea as the center, namely, the central area with the diameter of 1 mm, the inner ring of 1-3 mm and the outer ring of 3-6 mm. The inner ring area and the outer ring area are divided into upper, lower, nasal and temporal sides, respectively, which are denoted as S3, I3, N3, T3 and S6, I6, N6, T6, totaling 9 areas. To observe the distribution characteristics of choroidal thickness in different regions of two groups of eyes. The choroidal thickness of different macular regions was compared by independent sample t-test. Results:The choroidal thicknesses in the central area, S3, T3, I3, N3, S6, T6, I6, and N6 of the eyes in the control group and BRVO-ME group were 214.11±56.04, 207.89±57.92, 214.07±54.82, 207.14±61.54, 180.18±53.53, 204.25±59.60, 193.93±51.50, 190.54±51.21, 139.82±39.84 μm and 258.00±71.14, 256.43±68.70, 252.07±72.97, 244.37±68.49, 243.10±70.93, 247.20±68.36, 221.00±61.28, 223.77±58.64, 183.20±60.15 μm. In both groups, the choroidal thickness was the thickest in the central area, gradually thinning to the nasal side and temporal side, and the nasal choroidal thickness was thinner than other regions, and N6 area was the thinnest. Compared with the control group, the choroidal thickness of central area, S3, T3, I3, N3, S6, I6 and N6 in BRVO-ME group were significantly thicker ( t=-2.899, -2.229, -2.172,-3.250, -2.543, -2.292, -3.214; P<0.05), there was no significant difference in T6 area ( t=-1.814, P=0.075). Conclusion:The choroidal thickness of macular area in patients with BRVO-ME is thicker than that in normal subjects.

The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-<40 years, =86）, group B （40-<60 years, =107） and group C （≥60 years, =65）. The diagnosis was confirmed by 24 h pH-metry. The diagnostic rate, RSI and RFS scores were compared among the three groups. ROC curve was used to analyze the optimal thresholds for the diagnosis of LPR by RSI and RFS scores. Among the three groups, group C had the highest diagnostic rate（93.85%）. There was no significant difference in RFS score among the three groups （>0.05）, RSI score was significantly different （<0.05）, RSI score of group A and group B was higher than that of group C （<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.

Objective: The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. Method: From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-<40 years, n=86）, group B （40-<60 years, n=107） and group C （≥60 years, n=65）. The diagnosis was confirmed by 24 h pH-metry. The diagnostic rate, RSI and RFS scores were compared among the three groups. ROC curve was used to analyze the optimal thresholds for the diagnosis of LPR by RSI and RFS scores. Result: Among the three groups, group C had the highest diagnostic rate（93.85%）. There was no significant difference in RFS score among the three groups （P>0.05）, RSI score was significantly different （P<0.05）, RSI score of group A and group B was higher than that of group C （P<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. Conclusion The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.

Objective:To explore the cancer incidence and mortality in registration areas of Shanxi Province in 2014.Methods:The data of 12 cancer registration areas of Shanxi Province in 2014 were taken to analyze the characteristics of cancer incidence and mortality for patients with different age and gender in different areas. And then the results were compared with the malignant cancer incidence and mortality in the nationwide.Results:There were 11 703 new cases, including 6 559 males and 5 144 females in registration areas of Shanxi Province in 2014, and the incidence rate was 221.21/10 5, while the age-standardized incidence rate of Chinese population and world population was 163.91/10 5 and 163.25/10 5, respectively. The cancer incidence rate in urban areas was 247.02/10 5 and the age-standardized incidence rate of Chinese population was 171.35/10 5. In rural areas, the cancer incidence rate was 205.98/10 5 and the age-standardized incidence rate of Chinese population was 159.03/10 5. The common cancer sites were stomach, lung, esophagus, liver and colorectum for males. And breast, cervix, lung, esophagus, stomach were the common cancer sites for females. There were 7 283 malignant death cases, including 4 548 males and 2 735 females. The crude cancer mortality rate was 137.66/10 5, and the age-standardized mortality rate of Chinese population was 99.67/10 5 and world population was 100.11/10 5. The crude cancer mortality rate in urban areas was 141.03/10 5 and the age-standardized incidence rate of Chinese population was 92.84/10 5. In rural areas, the crude cancer mortality rate was 135.68/10 5 and the age-standardized mortality rate of Chinese population was 103.69/10 5. Male common malignant tumor deaths included lung cancer, gastric cancer, liver cancer, esophageal cancer and colorectal cancer, while lung, stomach, liver, esophagus and cervix were the common cancer death sites for females. Conclusions:The incidence and mortality of malignant tumors in registration areas in Shanxi Province are mainly lung cancer, upper gastrointestinal cancer and cervix uteri cancer. The incidence rates of stomach cancer and cervical cancer are high.