Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes,and to analyze factors affecting the MH closure rate.Methods This is a retrospective case study.21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study.All eyes were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A and/or B-scan ultrasound,optical coherence tomography and visual electrophysiological examination.The BCVA was ranged from finger counting to 0.2.The axial length (AL) was ranged from 26.00 to 31.00 mm,with an average of 27.47 mm.Among 22 eyes,AL was between 26.00 mm to 27.00 mm in 9 eyes,27.10 mm to 28.00 mm in 5 eyes,28.10 mm to 29.00 mm in 3 eyes,29.10 mm to 30.00 mm in 3 eyes,and longer than 30.00 mm in 2 eyes.The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm.Among them,the minimum diameter was between 200 μm to 400 μm in 4 eyes,401 μm to 450 μm in 13 eyes,451 μm to 500 μm in 3 eyes,501 μm to 600 μm in 2 eyes.All the eyes were treated with PPV combined with ILMP surgery.The average follow-up time was 17 months after surgery.The efficacy was determined at the final follow up,including the MH closure,the state of macular retinoschisis and the BCVA.MH closure rate with different MH diameters and different AL were compared and analyzed.Results During the final followup,MH were fully closed in 17 eyes (77.3％),bridge-closed in 4 eyes (18.2％) and not closed in 1 eye (4.5％).Retinoschisis was resolved in 19 eyes (86.4％),partially resolved in 2 eyes (9.1％) and not changed in 1 eye (4.4％).MH with smaller diameter had higher MH closure rate (x2=12.036,P=0.032).MH with longer AL had lower MH closure rate (x2=16.095,P=0.003).The final BCVA was ranged from finger counting to 0.25.Among 22 eyes,BCVA or metamorphopsia were improved in 9 eyes (40.9％),stable in 8 eyes (36.4％).BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7％).Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes.After surgery,MH was closed and retinoschisis was resolved in most patients.The major factors affect the MH closure were the minimum diameter of MH and AL.

The origin of nerves innervating the small intestine and oral part of the colon of the cat was studied by means of the retrograde axonal transport of HRP. Twelve adult cats were used in this experiment. The proximal cut end of the superior mesenteric plexus was immersed in HRP solution, in order to localize the neurons which contribute fibers to this plexus. Neurohistochemical procedures were processed according to Mesulam's tetramethylbenzidine (TMB) method. HRP labeled cells or fibers can be identified bilaterally in the following places: 1. The dorsal motor nucleus of the vagus nerve; about 80% of the labeled cells were found in a region from 0.4mm below to 2.0 mm above the obex, approximately at the rostral two-thirds of the middle segment of this nucleus. 2. The reticular formation of medulla; only a few cells labeled and 92% of them were located in an area from 0.2, mm to 2.7 mm above the obex. 3. The coeliac-superior mesenteric ganglion complex; almost all of the labeled cells were concentrated in the caudal part of it, near the origin of the superior mesenterie plexus. 4. The nodose ganglion; most of the oval or round labeled cells were of medium or small size, their diameters vary from 30 to 40?m, and the average total numbers of the labeled cells were 661 in the left and 695 in the right ganglion respectively. 5. The spinal ganglia; small round or oval labeled cells (25～45 ?m in diameter) were found in the left T_2 to L_5 and right T_2 to L_4 ganglia, with the most heavily labeled segments at T_(13) and L_1 (left, mean 365; right, mean 34% of all labeled cells). The average total number of the labeled Cells were 1872 in the left and 1698 in the right side. 6. Transganglionic labeled fibers were seen in the gracile nuclei of one cat, suggesting that HRP molecules are transported retrogradely in the peripheral process and anterogradely in the centrally projecting process of the same neuron of spinal ganglia.

A 56-year-old female was admitted to Department of Gastroenterology at Peking Union Medical College Hospital with diarrhea for seven months, and abnormal liver function for six months. She had a history of type 1 diabetes. The main clinical manifestations were recurrent fatty diarrhea and abnormal liver function, accompanied by abdominal and retroperitoneal lymphadenopathy, elevated CA19-9 and CEA. Progressive impairment of hepatic synthetic function and shrinkage of liver developed in a short period of time. The pathology of liver biopsy suggested that nodular regeneration of hepatocytes was followed by hyperplasia of thin bile ducts after submassive necrosis. Intestinal mucosa biopsies were performed twice. The pathology showed that the intestinal villi were completely blunt, accompanied with crypt hyperplasia. Goblet cells disappeared with reduced mucin. Paneth cells were barely seen without intraepithelial infiltration of lymphocytes. Rifaximin was not effective, while glucocorticoids improved clinical situation. The diagnosis of autoimmune enteropathy was finally confirmed by multidisciplinary team including departments of gastroenterology, pathology, endocrinology, hematology, infectious diseases, and rheumatology. With the administration of glucocorticoid and sirolimus, diarrhea relieved and liver function returned to normal.

Cockayne syndrome(CS)group B(CSB),which results from mutations in the excision repair cross-complementation group 6(ERCC6)genes,which produce CSB protein,is an autosomal recessive disease characterized by multiple progressive disorders including growth failure,microcephaly,skin photosensitivity,and premature aging.Clinical data show that brain atrophy,demyelination,and calcification are the main neurological manifestations of CS,which progress with time.Neuronal loss and calcification occur in various brain areas,particularly the cerebellum and basal ganglia,resulting in dyskinesia,ataxia,and limb tremors in CSB patients.However,the understanding of neurodevelopmental defects in CS has been constrained by the lack of significant neurodevelopmental and functional abnormalities observed in CSB-deficient mice.In this review,we focus on elucidating the protein structure and distribution of CSB and delve into the impact of CSB mutations on the development and function of the nervous system.In addition,we provide an overview of research models that have been instrumental in exploring CS disorders,with a forward-looking perspective on the substantial contributions that brain organoids are poised to further advance this field.

Infantile spasms(IS) is the prevalent epilepsy syndrome in infancy, characterized by an early age of onset, distinctive seizure type, hypsarrhythmia on electroencephalography, and psychomotor retardation.Despite the fact that medication therapy is the primary treatment for IS, there are still some children with IS who are resistant to drug therapy, which is extremely detrimental to their prognosis.Therefore, surgical therapy has increasingly become one of the most prominent IS treatments.As of now, the indications, preoperative evaluation, and surgical techniques of surgery are continuously being investigated based on variables such as the disease, etiology, age, etcetera.The effect of surgery on cognitive function, physical function, linguistic capacity, and memory function is gaining increasing interest.This article described the indications, preoperative evaluation, surgical procedures (including resection, palliative surgery, and stereotactic surgery), and postoperative efficacy of surgical treatment for IS, with the goal of improving the prognosis of IS through precise surgical treatment, and providing more treatment options and a good long-term prognosis for children with drug-resistant IS.

ObjectiveTo explore the impact of the interaction between occupational and non-occupational noise exposure on the risk of high-frequency hearing loss (HFHL) in noise-exposed workers. Methods A total of 602 male workers with normal hearing, engaged in an automobile manufacturing company between 2016 and 2018, were selected as the study subjects using the retrospective cohort study method. Pure-tone audiometry and questionnaire surveys were conducted on the workers. The Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression model were used to analyze the interaction between occupational and non-occupational noise exposure and the risk of HFHL in these workers. Results The prevalence of HFHL of the workers was 34.1% in 2020, without any cases of speech frequency hearing loss. Kaplan-Meier survival analysis result showed that the risk of HFHL increased in workers with excessive national occupational noise exposure intensity, self-reported noisy living environments, and both excessive national occupational noise exposure intensity and self-reported noisy living environments (all P<0.01). The results of the Cox proportional hazards model showed that the combined effect of excessive national occupational noise exposure intensity and self-reported noisy living environments [relative risk (RR)=2.40, P<0.01] was higher than the individual effects of excessive national occupational noise exposure intensity (RR=2.09, P<0.01) and self-reported noisy living environments (RR=2.39, P<0.01). There was an antagonistic effect between excessive national occupational noise exposure intensity and self-reported noisy living environments (interaction index <1.00). Conclusion Both occupational and non-occupational noise exposure can increase the risk of HFHL in noise-exposed workers, and there is an interaction between them.

Objective To analyze the spatial and temporal clustering characteristics of typhoid and paratyphoid fever and its change pattern in Yunnan, Guizhou and Guangxi provinces in southwestern China in recent years. Methods The incidence data of typhoid and paratyphoid fever cases at county level in 3 provinces during 2001-2012 were collected from China Information System for Diseases Control and Prevention and analyzed by the methods of descriptive epidemiology and geographic informatics. And the map showing the spatial and temporal clustering characters of typhoid and paratyphoid fever cases in three provinces was drawn. SaTScan statistics was used to identify the typhoid and paratyphoid fever clustering areas of three provinces in each year from 2001 to 2012. Results During the study period, the reported cases of typhoid and paratyphoid fever declined with year. The reported incidence decreased from 30.15 per 100000 in 2001 to 10.83 per 100000 in 2006 (annual incidence 21.12 per 100000);while during 2007-2012, the incidence became stable, ranging from 4.75 per 100000 to 6.83 per 100000 (annual incidence 5.73 per 100000). The seasonal variation of the incidence was consistent in three provinces, with majority of cases occurred in summer and autumn. The spatial and temporal clustering of typhoid and paratyphoid fever was demonstrated by the incidence map. Most high-incidence counties were located in a zonal area extending from Yuxi ofYunnan to Guiyang of Guizhou, but were concentrated in Guilin in Guangxi. Temporal and spatial scan statistics identified the positional shifting of class Ⅰ clustering area from Guizhou to Yunnan. Class Ⅰ clustering area was located around the central and western areas (Zunyi and Anshun) of Guizhou during 2001-2003, and moved to the central area of Yunnan during 2004-2012. Conclusion Spatial and temporal clustering of typhoid and paratyphoid fever existed in the endemic areas of southwestern China, and the clustering area covered a zone connecting the central areas of Guizhou and Yunnan. From 2004 to 2012, the most important clustering area shifted from Guizhou to Yunnan. Findings from this study provided evidence for the identifying key areas for typhoid and paratyphoid fever control and prevention and allocate health resources.

Objective To determine the correlation between obstructive sleep apnea syndrome (OSAS)and nonarteritic ischemic optic neuropathy (NAION).Methods It was a perspective study.A total of 41 consecutive patients with NAION (NAION group) and 41 age-and sex-matched physical examination subjects (control group) in Xi'an No.3 Hospital from December 2016 to December 2018 were enrolled in this study.The apnea hypopnea index (AHI,the number of sleep apneas per hour) was monitored using a polysomnography for patients in NAION group and control group.At the same time,the blood oxygen saturation was continuously recorded.The OSAS can be diagnosed if the AHI value was ≥ 5.OSAS severity was graded as mild:5≤AHI＜ 15;moderate:15≤AHI＜30;severe:AHI ≥30.The grading of OSAS severity between two groups was compared by Fisher's exact test.The AHI and minimum blood oxygen saturation were compared between NAION group and control group using the Mann-Whitney U test.Spearman correlation analysis was performed on the correlation between OSAS and NAION.Results Among the patients in the NAION group,31 patients (75.61％) were diagnosed with OSAS.Among them,6 patients (14.63％) were mild,9 patients (21.95％) were moderate,and 16 patients (39.03％) were severe.In the control group,19 patients (46.34％) were diagnosed with OSAS.Among them,10 patients (24.39％) were mild,5 patients (12.20％) were moderate,and 4 patients (9.75％) were severe.The difference of OSAS patients of mild,moderate and severe between two groups were statistically significant (Z=0.235,0.245,0.312;P=0.012,0.014,0.032).The average AHI of patients in the NAION group was 20.25 ± 7.74,and the mean minimum oxygen saturation at night was (87.38± 5.53)％.The average AHI of the control group was 18.67 ± 11.67,and the mean minimum oxygen saturation at night was (85.06+4.25)％.The differences of the mean AHI and mean minimum oxygen saturation between two groups were statistically significant (Z=1.124,2.317,P=0.003,0.020).There was a positive correlation between OSAS and NAION (Spearman correlation coefficient=0.229,P=0.030).Conclusion There is a positive correlation between OSAS and NAION.

Objective:To observe the correlation between obstructive sleep apnea syndrome (OSAS) and central serous chorioretinopathy (CSC).Methods:From October 2016 to December 2018, 50 cases of CSC patients (CSC group) and 50 healthy people (control group) matched by age and sex who were diagnosed in the ophthalmological examination of Xi’an No.3 Hospital were included in the study. According to the course of the disease, CSC was divided into acute phase and chronic phase, with 20 and 30 cases respectively. The average age ( Z=1.125) and body mass index (BMI) ( Z=0.937) of the two groups were compared, and the difference was not statistically significant ( P>0.05); the age of patients with different courses of CSC ( Z=1.525) and gender composition ratio ( χ2=0.397) and BMI ( Z=1.781) were compared, the difference was not statistically significant ( P>0.05). The Berlin questionnaire was used to assess the OSAS risk of subjects in the CSC group and the control group; polysomnography was used to monitor the apnea-hypopnea index (AHI) and minimum blood oxygen saturation (MOS) during night sleep. OSAS diagnostic criteria: typical sleep snoring, daytime sleepiness, AHI (times/h) value ≥ 5. The severity of OSAS was classified as mild OSAS: 5≤AHI<15; moderate OSAS: 15≤AHI <30; severe OSAS: AHI≥30. Non-normally distributed measurement data were compared by rank sum test; count data were compared by χ2 test. Spearman correlation analysis was performed on the correlation between OSAS and CSC. Results:The AHI data in the CSC group and the control group were 17.46±3.18 and 15.72±4.48 times/h, respectively; the MOS were (83.48±4.68)% and (87.40±3.82)%, respectively; those diagnosed with OSAS were respectively 36 (72.00%, 36/50) and 13 (26.00%, 13/50) cases. AHI ( Z=0.312), MOS ( Z=0.145), and OSAS incidence ( χ2=21.17) were compared between the two groups of subjects, and the differences were statistically significant ( P=0.028, 0.001,<0.001). The AHI of acute and chronic CSC patients were 15.95±3.02 and 18.47±2.92 times/h; the MOS were (86.10±11.07)% and (81.73±4.58)%, respectively. There were statistically significant differences in AHI ( Z=0.134) and MOS ( Z=0.112) in patients with different course of disease ( P=0.005, 0.001). The results of Spearman correlation analysis showed that OSAS and CSC were positively correlated ( r=0.312, P=0.031). Conclusion:OSAS may be a risk factor for the onset of CSC.

Objective:To investigate the dosimetric effects of prone immobilization devices combined with a belly board (PIDBBs) in the intensity-modulated radiotherapy (IMRT) for gynecologic cancers.Methods:A total of 20 patients with cervical or endometrial cancer treated with radiotherapy in the Third Affiliated Hospital of Sun Yat-sen University from August 2020 to June 2021 were retrospectively analyzed. Two sets of body contours were outlined for each patient. One set of body contours did not contain the immobilization devices, and the other contour set included the immobilization devices. For each patient, doses were calculated for the two sets of contours using the same 7-field IMRT plan and were recorded as Plan without and Plan with. The dosimetric difference caused by the immobilization devices was assessed by comparing the parameter values in the dose-volume histograms (DVHs) and by plan subtraction. The Gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results:The target coverage and average dose of Plan with were lower than those of Plan without. Specifically, the V50 Gy, V49 Gy, and Dmean of planning target volume (PTV) decreased by 19.75%, 7.99%, and 2.54% ( t = 8.96, 10.49, 22.09, P < 0.01), respectively. The V40 Gy, V30 Gy, V20 Gy, V15 Gy, and Dmean of skins increased by 51.79%, 51.05%, 45.72%, 33.63% and 10.80% ( t = -2.54, -5.63, -15.57, -24.06, -13.88, P < 0.01), respectively. Doses to other organs at risk (OARs) showed no significant differences. As indicated by the EBT3 measurements, the doses to skins of the abdomen and pelvis on the anthropomorphic phantom increased by approximately 37.24% ( t = 10.86, P<0.01). Conclusions:Although PIDBBs can effectively reduce the low dose to the small intestine, the radiation attenuation caused by them can reduce the PTV coverage of radiotherapy plans and increase the doses to abdominal and pelvic skins sharply, especially for patients requiring irradiation of the groin and perineum.