The change of human cytochrome P450 1A2 ontogeny and the effect of its gene polymorphism on clinical medication were reviewed. The relevant literatures from various databases were searched, collected, analyzed and summarized. CYP1A2 is one of the major subfamilies in human liver enzyme. It is involved in metabolism of about 8%-10% of drugs in clinic, which has important pharmacological and toxicological implications.The expression and activity of CYP1A2 enzymes were different during development, which had a significant effect on clinical medication in human. Studies can see clearance rates and elimination half-lives differences by using caffeine as a probe substrate.Gene polymorphisms cause activity differences of CYP1A2. Gene polymorphisms of CYP1A2*1C and CYP1A2*1F, have been extensively studied show significant effects on clinical medication in adults.There are very few studies on medication between CYP1A2 gene polymorphism and enzyme activity in premature infants, infants and children. The effect of CYP1A2 enzyme activity is unknown between gene polymorphism and ontogeny interaction during human development.It is very necessary to further study the ontogeny changes of CYP1A2 and its gene polymorphism on drug metabolism for improving the safety and efficacy medication in children.

21-hydroxylase deficiency (21-OHD) is an autosomal recessive hereditary disease, which results in reduced synthesis of aldosterone and cortisol and increased adrenal androgens due to lack or reduced activity of 21-hydroxylase during the synthesis of adrenal steroids.In recent years, the " backdoor" metabolic pathway of adrenal androgen synthesis and the role of adrenal specific 11-oxygenated C19 steroid in 21-OHD have been recognized, and some adrenal specific androgen sources are gradually becoming diagnostic and therapeutic indicators for 21-OHD.On basis of original glucocorticoid and salt corticosteroid replacement therapy, new drugs and treatments are gradually developed and applied in clinical practice.Nov, the latest progress in diagnosis, treatment and monitoring of 21-OHD is reviewed.

Objective: To investigate the influence of angiotensinreceptor neprilysin inhibitor(ARNI) and angiotensin converting enzyme inhibitor (ACEI) on clinical efficacy and safety of elderly patients with ischemic cardiomyopathy. Methods: From January 2017 to December 2018, 120 elderly patients with ischemic cardiomyopathy in the Third People′s Hospital of Cixi were divided into 2 groups according to treatment methods, 59 patients treated with ACEI (control group) and 61 patients treated with ARNI (observation group) on the basis of conventional intervention. The levels of blood lipid index, blood pressure index, B-type brain natriuretic peptide (BNP), 6- minute walking test (6MWT) and echocardiographic index, endothelium-dependent diastolic function of brachial artery (FMD) and carotid intima-media thickness (CIMT) before and after treatment were compared. The adverse reactions incidence of 2 groups were compared. Results: The levels of blood lipid index and blood pressure index after treatment of 2 groups were significantly lower than those before treatment, and the differences had statistical significant (P<0.05). There were no significant differences in the levels of blood lipid index and blood pressure index after treatment between 2 groups (P>0.05). After treatment of 12 weeks, the levels of BNP, 6MWT, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension(LVEDD) of observation group were significantly better than those of control group [(103.50 ± 23.95) ng/L vs. (175.20 ± 37.24) ng/L, (493.47 ± 92.54) m vs. (411.42 ± 61.09) m, (44.95 ± 5.89)% vs. (41.54 ± 4.21)%, (149.59 ± 33.26) mm vs. (143.24 ± 34.25) mm](P<0.05). The level of brachial artery FMD after treatment of observation group was significantly higher than that of control group [(15.14 ± 2.52)% vs. (9.25 ± 1.12)%](P<0.05). The level of CIMT after treatment of observation group was significantly lower than that of control group [(1.01 ± 0.28) mm vs. (1.32 ± 0.25) mm](P<0.05). There was no significant difference in the adverse reactions incidence between 2 groups (P>0.05). Conclusions ARNI in assisted treatment of elderly patients with ischemic cardiomyopathy can efficiently improve cardiac function, increase exercise endurance, enhance vasodilation function and dose not aggravate adverse drug reactions.

AIM: To investigate the curative effect of polyethylene glycol(PEG)eye drops, polyacrylic acid(PAA)eye gel and sodium hyaluronate(SH)eye drops on dry eye syndrome after phacoemulsification.

METHODS: Patients with age-related cataract who underwent phacoemulsification and intraocular lens implantation in the hospital from February 2015 to January 2018 were enrolled in the study. They were divided into PEG group, PAA group and SH group according to the application type of artificial tears. The clinical symptom scores, Schirmer I test, break-up time(BUT)and corneal fluorescein staining were observed and analyzed at 7, 14 and 30d after operation in the three groups. The curative effects were evaluated.

RESULTS: After 14 and 30d of operation, the score of dry eye symptom, Schirmer I and BUT in SH group were significantly better than those in PEG group and PAA group(P<0.05). The staining score and tear film imaging score in SH group were significantly lower than those in the other two groups at 30 days after operation(P<0.05). There was no significant difference in all indexes between PEG group and PAA group(P>0.05).

CONCLUSION: PEG drops, PAA eye gel and SH eye drops all can alleviate the clinical symptoms of dry eye patients after cataract surgery, improve the state of tear film, which have good clinical curative effects. SH eye drops may be more advantageous.

AIM: To investigate the application and therapeutic effect of allogeneic sclera transplantation combined with arbitrary flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect.

METHODS: Medical records of 103 patients(103 eyes)who underwent allogeneic scleral transplantation combined with random flap plasty in the treatment of moderate and severe deep and full-thickness eyelid defect from June 2017 to June 2020 were retrospectively reviewed. All patients were followed up for 1-6mo after operation was performed to evaluate the postoperative effects of the resorption and compatibility of allogeneic sclera, the survival situation of skin flaps, eyelid appearance, eyelid closure, eyelid scar.

RESULTS: Follow up observation from 1-6mo after operation, the allogeneic sclera was gradually replaced by the receptor tissue, allogeneic sclera in the inner layer of the eyelid was covered with conjunctival cells, allogeneic sclera and skin join closely together in the outer layer of the eyelid. There was no rejection in allogeneic sclera. All patients had survived skin flaps, good eyelid shape, natural eyelid closure, and no scars.

CONCLUSION: The allogeneic sclera transplantation combined with random flap plasty has curative effect in the repair of moderate and severe deep and full-thickness eyelid defect. It has both function and aesthetics result, and it is suitable for clinical promotion.

Objective To observe the effects of implementing lung protective ventilation strategies on lung dynamic compliance and oxygenation function in elderly emergency surgery patients.Methods A total of 126 elderly patients undergoing emergency surgery admitted to Northern Jiangsu People's Hospital from December 2021 to December 2022 were selected.They were randomly divided into an observation group and a control group,with 63 patients in each group,using a random number table method.All selected cases underwent general anesthesia mechanical ventilation during surgery.The control group chose conventional ventilation mode,while the observation group adopted lung protective ventilation.The lung dynamic compliance,oxygenation function,inflammatory indicators,and complications of the two groups of patients were compared.Results Within 30 minutes of surgery,the mean airway pressure(Pmean)and peak airway pressure(Ppeak)levels of both groups of patients increased compared to preoperative levels.The observation group had a smaller increase than the control group(P<0.05),and the pulmonary dynamic compliance(Cdyn)levels were lower than preoperative levels.The observation group had a lower increase than the control group(P<0.05).After 2 hours of surgery,the levels of Pmean and Ppeak in both groups of patients decreased compared to 30 minutes during surgery,and the decrease in the observation group was smaller than that in the control group(P<0.05).The levels of Cdyn in both groups decreased compared to before surgery,and the observation group was lower than that in the control group(P<0.05).24 hours after surgery,the blood oxygen saturation(SpO2)and arterialpartial pressure of oxygen(PaO2)levels in both groups of patients decreased compared to before surgery,and the observation group was lower than the control group(P<0.05).The alveolar-arterial oxygen partial pressure difference[P(A-a)DO2]levels between the two groups increased compared to preoperative levels,and the observation group was higher than the control group(P<0.05).48 hours after surgery,the SpO2 and PaO2 levels in the observation group were higher than those in the control group,and the P(A-a)DO2 levels were lower than those in the control group(P<0.05).24 hours after surgery,the serum C-reactive protein(CRP)and white blood cell(WBC)levels in both groups were significantly increased compared to preoperative levels,and the observation group was higher than those in the control group(P<0.05).48 hours after surgery,the serum CRP and WBC levels of both groups of patients decreased compared to 24 hours after surgery,and the observation group was lower than the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(7.94％vs.25.40％)(P<0.05).Conclusion Implementing lung protective ventilation strategies for elderly emergency surgical patients is beneficial for improving lung dynamic compliance and oxygenation function,inhibiting the release of inflammatory cytokines,reducing the incidence of postoperative pulmonary complications,and effectively exerting lung protective effects.

Objective: To observe the effects of miR-204 on the proliferation and invasion of retinoblastoma (RB) cells and to explore the potential regulatory mechanism. Methods: The expression level of miR-204 in RB cell lines (Y79, SO-RB50, and HXO-Rb44) as well as in normal human retinal pigment epithelial cell line hTERT RPE-1 was detected using qRT-PCR. The Y79 cells were divided into two groups (negative control group and miR-204 group) by respectively transfecting Y79 cells with NC-mimics and miR-204 mimics using liposome transfection method. The effects of miR-204 on Y79 cell proliferation was detected with CCK-8 assay; while the effect of miR-204 on migration and invasion of Y79cellsweredeterminedbycellscratchassayandTranswellassay,respectively.Besides, thepotentialtargetgeneofmiR-204waspredictedbybioinformatics;and the influence of miR-204 on the expression of high mobility group AT-hook 2 gene (HMGA2) at both mRNA and protein levels was detected using qRT-PCR and Western blotting, respectively. Results: miR-204 expression in RB cell lines Y79, SO-RB50 and HXO-Rb44 was remarkably lower than that in normal human retinal pigment epithelial cell line hTERT RPE-1 (P<0.01). miR-204 expression in Y79 cells was markedly up-regulated after transfection with miR-204 mimics (P<0.01) along with significantly reduced cell proliferation, migration and invasion capacities (all P<0.01), and mRNA and protein expressions of HMGA2 were also outstandingly reduced (P<0.01). Conclusion: miR-204 is lowly expressed in RB cell lines; in addition, miR-204 over-expression can suppress RB cell proliferation, migration and invasion, the mechanism of which might be related to down-regulation of the expression of HMGA2.

Objective: To explore the effect of PDCA nursing model combined with token reward on the compliance and negative emotions of children with hypospadias. Methods: A total of 120 children with hypospadias who were admitted to Children′s hospital affiliated to Zhengzhou University from February 2017 to December 2017 were selected as study subjects. According to the time of admission, they were divided into observation group and control group, with 60 cases in each group. The control group was given routine nursing care, the observation group was given PDCA nursing mode combined with token rewards intervention on the basis of routine care. The self-made children's behavioral compliance assessment table was used to compare the compliance of the two groups of children. Achenbach Child Behavior Check List (CBCL) scores were performed before and after the intervention. The hospitalization time and the incidence of complications were calculated. Results: There was no significant difference in CBCL scores between the two groups at admission (t=0.965, P=0.102). The scores of compliance and CBCL scores of the observation group were (43.12±3.99) points and (17.62±7.30) points respectively, the scores of control group were (30.67±4.53), (24.23±6.67), the difference was statistically significant (t=15.977, 5.184, P<0.01). The hospitalization time and complication rate of the observation group were (18.73±0.84)d, 15.00% (9/60), which were significantly lower than (20.92±1.90) d, 31.67% (19/60) of the control group, and the difference was statistically significant (t=8.166, χ²=4.658, P<0.01 or 0.05). Conclusions The PDCA nursing model combined with token reward can improve the compliance of children with hypospadias and improve their negative emotions.

Objective: To evaluate the clinical value of non-contrast-enhanced MR angiography (NCE-MRA) combined with captopril renal scintigraphy (CRS) in the diagnosis of renovascular hypertension (RVH). Methods: A total of 52 patients (33 males, 19 females; age: (54.5±16.3) years) with highly suspected RVH between January 2018 and October 2018 from Henan Provincial People′s Hospital were retrospectively analyzed. The examination data of NCE-MRA, basic renal dynamic imaging, CRS and digital subtraction angiography (DSA) were collected and reviewed. The renal artery stenosis (RAS) rate≥70% was the criterion for RVH diagnosed by DSA, which was considered as the gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of NCE-MRA, CRS and NCE-MRA+ CRS were determined. The consistency between NCE-MRA and DSA was analyzed by Kappa test. The differences of diagnostic efficiencies between CRS and NCE-MRA + CRS were compared by χ² test or Fisher exact test. Results: There was a high consistency between NCE-MRA and DSA in the diagnosis of RVH (Kappa=0.81, 95% CI: 0.62-0.96; P<0.01). The diagnostic sensitivity, specificity, accuracy, PPV and NPV of NCE-MRA were 88.89%(24/27), 92.00%(23/25), 90.38%(47/52), 92.31%(24/26), and 88.46%(23/26) respectively, those of CRS were 81.48%(22/27), 72.00%(18/25), 76.92%(40/52), 75.86%(22/29) and 78.26%(18/23) respectively, and those of NCE-MRA+ CRS were 74.07%(20/27), 100%(25/25), 86.54%(45/52), 100%(20/20) and 78.12%(25/32) respectively. Compared with CRS, the specificity (P=0.01) and PPV (P=0.03) of NCE-MRA+ CRS in the diagnosis of RVH were increased. Conclusion NCE-MRA and CRS are effective in the diagnosis of RVH, and the combination of two methods can significantly improve the diagnostic specificity and PPV than CRS alone.

Early days in life can not only affect people′s physiology, immune system, metabolism and structural development, but also can alter body cell functions in long term, which in turn has an impact on human′s health and diseases both in short and long term.Thus, early days, especially the first thousand days in life play an important role in human health and is thought to be a key period for preventing certain diseases later in life, which is under heated investigation.However, the mechanisms for this impact are not clear.This review emphasizes the importance of the first thousand days in human life and elucidates its association with human health from multiple aspects.