Diabetic retinopathy is a series of typical pathological changes in retinal microvasculature caused by diabetes,which seriously affects the visual acuity and quality of life of patients.The development of spectral-domain optical coherence tomography provides a new approach to elucidate the pathogenesis of diabetic retinopathy,and this paper will give a brief review on the latest progress in the relationship between choroidal thickness measured by optical coherence tomography and diagnosis-treatment of diabetic retinopathy.

In order to explore the relationship between dietary pattern and C-reactive protein (CRP) in Xiamen residents, 2 904 subjects from 3 districts of Xiamen City were selected by a multi-stage stratified random sampling method. The food frequency questionnaire was used for dietary survey and serum CRP concentration was determined simultaneously. The dietary model was established by factor analysis and the relationship between different dietary patterns and serum CRP concentration was analyzed. Five dietary patterns were obtained by the factor analysis. After the adjustment of gender, age, occupation, education, marriage status, income, smoking, drinking and body mass index, the healthy dietary pattern was negative associated with the serum CRP concentration [OR(95%CI):0.62(0.42-0.90)]. The Serum CRP concentration of residents with a healthy dietary pattern is lower.

Objective:To investigate the optimal emergency endoscopy timing in patients with esophagogastric variceal bleeding (EGVB).Methods:The clinical data of patients with EGVB emergency endoscopy in Renmin Hospital of Wuhan University from December 2018 to November 2020 were collected and analyzed. According to the time interval from admission to the start of emergency endoscopy, they were divided into emergency endoscopy group (<6 h, n=115) and early endoscopy group (6-24 h, n=57). The baseline data, clinical efficacy and postoperative situation of the two groups were compared, and the risk factors of 6-week mortality of EGVB emergency endoscopy were analyzed by univariate and multivariate analysis. Results:In terms of baseline characteristics, there were no significant differences in age, gender, causes, shock index, model for end-stage liver disease (MELD) score, charlson complication index (CCI) score, portal hypertension related complications between the two groups ( P<0.05). However, the albumin (ALB) in emergency endoscopy group was significantly lower than that in early endoscopy group ( P<0.001). There were significant differences in Child Pugh grading and Child Pugh score between the two groups ( P=0.002, P=0.001). In terms of endoscopic efficacy, the detection rate of bleeding site in emergency endoscopy group was significantly higher than that in early endoscopy group (90.4% and 73.7%, P<0.05). There was no significant difference in operation duration, immediate hemostasis success rate, 5-day rebleeding rate, rescue treatment demand and 6-week mortality between the two groups ( P>0.05). There was no significant difference in bleeding related death between the two groups ( P>0.05). In addition, there was no significant difference in blood product consumption, intensive care unit (ICU) stay and total hospital stay between the two groups ( P>0.05). Multivariate analysis showed that Child Pugh grade C ( P=0.018), MELD score ( P=0.005) and CCI score ( P=0.001) were independent risk factors for 6-week death outcome of EGVB patients, while emergency endoscopic intervention time was not related to 6-week death outcome ( P=0.5). Conclusions:The efficacy of early endoscopic intervention is no worse than that of emergency endoscopic intervention, except for the identification of bleeding site. Child-Pugh grade C, MELD score, and CCI score are the independent risk factors for 6-week mortality, while the timing of emergency endoscopy is not associate with 6-week mortality in EGVB patients.

Objective To study clinical features and mechanism in patients suffered from chronic hepatitis B achieving seroconversion of HBsAg by combination treatment with interferon (IFN) and nucleoside analogue (NA). Methods Thirty-two cases with chronic HBV hepatitis were enrolled into this retrospective study. All of them received combination treatment with IFN and Lamivudine/Adefovir, as well as achieved seroconversion of HBsAg from June, 2001 to May, 2007. All the cases in this study were followed up. Results Generally, serum HBV DNA fell below the detection limit 3 to 6 months after starting combination treatment. Virological breakthrough/relapse or new clinical resistant had not been found in all enrolments after combination treatment, including patients with previous resistant to Lamivudine, although the average length of treatment was over 2 years. The average period of following up after seroconversion of HBsAg was 13.2 months. Two cases transfered back to HBsAg positive, one of them achieved seroconversion of HBsAg again by the anti-virus treatment, and the other one gave up treatment and remained anti-HBe positive and HBeAg negative.The other 30 eases kept at the stage of seroconversion of HBsAg. Seven patients underwent liver biopsy after seroconversion of HBsAg, and 3 of them had taken liver biopsy before combination therapy too. Biopsy specimens were scored for fibrosis and neeroinflammation according to the Knodell histological activity index. Six cases showed HBsAg and HBcAg negative by immunohistochemistry,and only 1 case with HBsAg positive in liver tissue experienced relapse. Inflammation and fibrosis grade of the 3 cases who had taken liver biopsy twice were lowered after HBsAg seroconversion,although the ALT level of 1 case who had turned from G2S4 to GIS2-3 remained abnormal after HBsAg seroconversion. According to the sequence and character of HBsAg seroconversion, there were three models of HBsAg conversion. The sequence of transition was HBV DNA→HBeAg→HBsAg,which was dominant one, accounting for 59%(19/32 cases). HBV DNA negative, and the titer of HBeAg wandering at a low level, after then HBeAg and HBsAg change to negative in the same time,31% (10/32 cases). The titer of HBsAg decreased rapidly after the HBV DNA clearance, and the HBsAg clearance was earlier than HBeAg, 9% (3/32 cases). After 1 year of combination therapy,there were 15 of 21 cases (71.4%) whose titer HBsAg showed less than 100 COI by agent from Roche, and 7 of 11 cases (63.6%) whose titer HBsAg showed less than 250 IU/L by agent from Abbott. The frequency of adverse reaction was similar with that induced by IFN monotherapy, and no new adverse reaction was found. Conclusions Combination therapy and long course treatment might be the key to achieve the HBsAg seroconversion. Those with HBsAg in liver tissue and (or) low serum anti-HBs are more likely to relapse. The titer of HbsAg<100 COI (Roche, Germany) or<250 IU/L (Abbott, USA) after one year treatment may be regarded as a predict index of HBsAg seroconversion.

Objective:To summarize the best evidence of physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD).Methods:According to the 6S evidence model, BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) database, National Guideline Clearinghouse (NGC), National Institute for Health and Clinical Excellence (NICE) network, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), New Zealand Guideline Group (NZGG) network, Registered Nurses′ Association of Ontario (RNAO) network, Medlive, PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Knowledge Data Service Platform, VIP database and Chinese Biomedical Database and European Respiratory Society/American Thoracic Society were searched systematically to obtain guidelines, expert consensus, best practice information book, clinical decision-making, recommended practice, and systematic review on PA management in patients with COPD. The data retrieval time was from the establishment of the databases to April 30, 2022. Two researchers with evidence-based medicine background evaluated the quality and extracted evidence of the included literature.Results:A total of 19 articles were selected including 4 guidelines, 2 clinical decision, 9 systematic reviews, 3 expert consensus and 1 randomized controlled trial. Finally, 33 pieces of best evidence were formed from 10 themes, namely pre-exercise assessment, exercise prescription, exercise style, time, intensity, PA location, safety and effectiveness of PA, intervention strategies, effect evaluation and quality control.Conclusions:This study summarizes the best evidence of PA in patients with COPD. Health professionals should choose and apply the best evidence with consideration of the clinical situation and patient preference.

Objective To improve the cliniciansˊ awareness of Kluver-bucy syndrome (KBS), we retrospectively analyzed 4 cases of KBS such as clinical manifestation, MRI feature, treatment and prognosis. Methods We performed a retrospective analysis on 4 cases of KBS including general clinical data, key clinical symptoms, findings from cerebrospinal fluid and Cranial MRI examination, treatment strategy and prognosis, and literature review. Results All four patients showed KBS in the course of primary disease. The clinical symptoms of KBS mainly presented as gentle, indiscriminate dietary behavior, hypersexuality, hypermetamorphosis, hyperorality and visual agnosia. MRI Showed primary disease-associated alterations in diverse brain regions including hippocampus, the temporal lobe, the insula, the frontal lobe, and the cingulate gyrus. Three cases achieved completely clinical remission after treatment with carbamazepine,fluoxetine and antipsychotic drugs. One patientˊs symptoms disappeared spontaneously and no recurrence of symptoms was observed in the following 6~12 months. Conclusion Bulimia is often the first symptom of KBS. Cranial MRI is the characteristic of the primary disease and has great diagnostic value. Treatment with antiepileptic and antipsychotics can achieve favorable prognosis.

Objective:To investigate the predictive value of stimulated thyroglobulin (sTg) before the first 131I therapy for children and adolescents with differentiated thyroid carcinoma(DTC). Methods:Between January 2009 and December 2018, a total of 166 children and adolescents DTC patients (28 males, 138 females; age (16.5±3.0) years) from West China Hospital of Sichuan University were retrospectively analyzed. All patients underwent total thyroidectomy and 131I therapy. According to the treatment response evaluated 6-12 months after 131I therapy, patients were divided into excellent response (ER) group and incomplete response (non-ER) group. Clinical and pathological characteristics of 2 groups were compared using independent-sample t test, Mann-Whitney U test, χ2 test or Fisher′s exact test. The independent predictors for 131I treatment response were analyzed by logistic regression analysis. The cut-off value of sTg for predicting ER was determined by receiver operating characteristic (ROC) curve analysis. Results:Sixty-one patients achieved ER, while treatment response in 105 patients was non-ER. The level of sTg in non-ER group was significantly higher than that in ER group (52.5(11.8, 259.1) and 3.0(1.5, 9.7) μg/L; z=6.508, P<0.001). In addition, age, risk stratification, N stage, M stage, ratio of invaded lymph nodes and activities of 131I administered were also significantly different between those 2 groups ( t=2.611, 3.000, z=2.678, χ2=11.432, 16.299; all P<0.05). The level of sTg (odds ratio ( OR)=1.156, P=0.002) and administered activity of 131I ( OR=0.958, P=0.048) were independent predictors for the responses. ROC curve analysis showed that the best cut-off value of sTg for predicting ER was 16.1 μg/L with the sensitivity of 72.4%(76/105) and the specificity of 96.7%(59/61). Conclusions:sTg has the capability of predicting the response to the first 131I therapy in children and adolescents with DTC. When sTg is lower than 16.1 μg/L, the probability of ER increases.

Objective: This study aims to evaluate the efficacy of specific exercise therapy for the treatment of skeletally immature idiopathic scoliosis (IS). Methods: A total of 51 mild IS patients receiving specific exercise therapy in Guangdong Xinmiao Scoliosis Prevention Center from October 2017 to September 2021 were recruited in this study. Treatment outcome were evaluated at 1 year follow up. All the participants were divided into two groups: open ( n =32) and closed triradiate cartilage group ( n =19), and outcome of treatment were compared within the two groups. Results: After (26.5±9.8) months of treatment, the Cobb angle of the major curve was corrected from an average of (15.5±4.2)° to (11.3±6.7)°, with an average correction of (4.5±5.7)°. Among them, 58.9% patients achieved improvement in the major curve Cobb angle, 33.3% achieved stabilization, and 7.8% progressed. There was no significant difference in the major curve Cobb angle between the closed and open triradiate cartilage groups before treatment( t =-0.73, P =0.47), whereas there was a significant difference in the correction of the major curve after treatment( t =-2.73 , P <0.05). Conclusion Specific exercise therapy effectively prevents the progression or corrects the scoliosis in patients with skeletally immature idiopathic scoliosis. It s more effective in patients with open triradiate cartilage than in those with closed triradiate cartilage.

Cardiotoxicity of cancer chemotherapeutics has received considerable attention in recent years.However, the effects of chemotherapy on cardiometabolic perturbation with lung injury have rarely been reported. Thus, we constructed a mouse model of myocardial injury superimposed on lung injury with a combination of bleomycin (BLM) and doxorubicin (DOX).C57BL/6J mice were randomly divided into four groups: control group (CON), BLM group (intratracheal infusion with single doses of 5 mg/kg), DOX group (intraperitoneal injection of 7.5 mg/kg/week, two weeks) and DOX+BLM group. The cardiac injury of mice was evaluated by serum biochemical parameters and histopathology.Cardiometabolic perturbation was investigated using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography with tandem mass spectrometry (LC-MS).The results showed that, compared with the CON group, BLM alone caused lung injury yet with no significant effects on the cardiometabolic profile; DOX alone had significant perturbations in the cardiometabolic profile, and the main differential metabolites were amino acids, fatty acids, phospholipids, etc.; the combination of BLM and DOX caused more severe disturbance of cardiometabolic homeostasis in mice, especially accumulation of branched-chain amino acids.This study confirmed that DOX can lead to more significant changes in the cardiometabolic profile in the presence of lung injury, with an initial focus on the branched-chain amino acid metabolic pathway.This research provides scientific data for in-depth study of the cardiotoxicity mechanism of chemotherapeutic agents.