Objective To explore the risk prediction model of major adverse cardiovascular events (MACE) in community patients with hypertension based on remote ambulatory blood pressure parameters. Methods From November 2023 to October 2024, 486 community patients with hypertension who received standardized management in Nanjing Medical University Affiliated to Suzhou Hospital were retrospectively selected. All patients wore remote ambulatory blood pressure monitor to obtain 24-hour ambulatory blood pressure data. Clinical data were collected and remote ambulatory blood pressure parameters [24-hour systolic blood pressure variability (SBPV), 24-hour diastolic blood pressure variability (DBPV), nighttime SBPV, nighttime DBPV, daytime SBPV, daytime DBPV] were extracted. The patients were followed up for 12 months, and were classified into MACE group (n=42) and non-MACE group (n=444) according to whether MACE occurred during follow-up. Multivariate Logistic regression analysis was adopted to screen the influencing factors for MACE. Based on the above factors, a risk prediction model was constructed and verified by receiver operating characteristic (ROC) curve. Results MACE occurred in 42 cases among 486 patients, with an incidence rate of 8.64%. Multivariate Logistic regression analysis suggested that nighttime DBPV (OR=1.119, 95%CI: 1.030-1.214), 24h-SBPV (OR=1.115, 95%CI: 1.007-1.235), nighttime SBPV (OR=1.116, 95%CI: 1.016-1.226) and diabetes mellitus (OR=2.762, 95%CI: 1.059-7.203) were independent factors for MACE (P<0.05). The model validation results revealed that the area under the ROC curve was 0.905 (95%CI: 0.854-0.956 ), and the model had a good discrimination degree. Conclusion Nighttime DBPV, 24h-SBPV, nighttime SBPV and diabetes mellitus are independent risk factors for MACE in community patients with hypertension. The clinical prediction model based on these variables exhibits certain predictive value on MACE risk.

Medical ultrasound technology is widely used for diagnosis and therapy in clinical practice.Ultrasound probes,which are directly contact with patients,pose a potential risk of pathogen transmission.This expert consen-sus was developed by a multidisciplinary team based on international guidelines,standards in China,and the results of a national survey,aiming to reduce the risk of healthcare-associated infection through standardizing reprocessing of medical ultrasound probes,and formulating consensus recommendations with the Delphi method.The consensus clarifies the reprocessing principles for three types of ultrasound probes of different infection risks:external-use ul-trasound probes,interventional percutaneous ultrasound probes,and internal-use ultrasound probes,puts forward systematic suggestions on the reprocessing standards and disinfection levels of ultrasound probe isolation covers and coupling agents,the reprocessing procedures and methods of ultrasound probes,as well as architectural layout and management of reprocessing,so as to provide a scientific prevention and control framework for ensuring ultrasound diagnosis and therapy safety.

Objective To investigate the predictive value of serum lactate dehydrogenase(LDH)level com-bined with high-throughput sequencing in children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods The clinical data of 99 children with Mycoplasma pneumoniae pneumonia(MPP)admitted to Hua-zhong University of Science and Technology Union Hospital from October 2023 to March 2024 were retro-spectively analyzed.According to the severity of the disease,the children were divided into mild group(33 ca-ses)and severe group(66 cases).Spearman correlation analysis was used for correlation analysis,Logistic re-gression was used to analyze the influencing factors of SMPP,and the receiver operating characteristic(ROC)curve was used to evaluate the value of LDH in predicting SMPP.Results The level of LDH in the severe group was higher than that in the mild group(P<0.05).The results of high-throughput sequencing showed that the proportions of virulence positive and drug resistance gene A2063G mutation in the severe group were higher than those in the mild group(P<0.05).Multivariate Logistic regression analysis showed that LDH level and drug resistance gene A2063G mutation were related to the SMPP(P<0.05).ROC curve analysis showed that LDH combined with high-throughput sequencing detection of drug resistance gene A2063G muta-tion had a high value in predicting SMPP,and the area under the curve was 0.724.Conclusion Serum LDH combined with high-throughput sequencing detection of drug resistance gene A2063G mutation can be used as an effective indicator to predict SMPP.

Medical ultrasound technology is widely used for diagnosis and therapy in clinical practice.Ultrasound probes,which are directly contact with patients,pose a potential risk of pathogen transmission.This expert consen-sus was developed by a multidisciplinary team based on international guidelines,standards in China,and the results of a national survey,aiming to reduce the risk of healthcare-associated infection through standardizing reprocessing of medical ultrasound probes,and formulating consensus recommendations with the Delphi method.The consensus clarifies the reprocessing principles for three types of ultrasound probes of different infection risks:external-use ul-trasound probes,interventional percutaneous ultrasound probes,and internal-use ultrasound probes,puts forward systematic suggestions on the reprocessing standards and disinfection levels of ultrasound probe isolation covers and coupling agents,the reprocessing procedures and methods of ultrasound probes,as well as architectural layout and management of reprocessing,so as to provide a scientific prevention and control framework for ensuring ultrasound diagnosis and therapy safety.

Objective: To analyze the relationship between family behaviors and overweight/obesity in primary and junior school students aged 6-14 years in Xuzhou, and to provide a reference for a targeted measure to prevent and control overweight and obesity. Methods: Using multistage stratified cluster random sampling, a total of 6 220 students aged 6-14 years old from 10 primary schools and 10 junior schools were investigated by a self-designed questionnaire. Chi-square and multivariate Logistic regression models were used to explore the relationship between family behaviors and overweight/obesity in primary and junior school students. Results: The rate of overweight/obesity in primary and junior boys was higher than that in primary and junior girls. The rate of overweight/obesity in urban students was higher than that of rural students(P<0.05). The Chi-square analysis showed that overweight of parents, irregular breakfast, eating fast food, eating sweets, drinking sweetened beverage, long screen time and short sleep duration were risk family behavior factors of overweight/obesity in primary and junior boy students(P<0.05). The risk family behavior factors of overweight/obesity in primary and junior girl students were overweight of parents, irregular breakfast, eating fast food and eating sweets(P<0.05). The risk family behavior factors of overweight/obesity, such as drinking sweetened beverage and short sleep duration, were also related to primary girls(P<0.05), and long screen time was related to junior girls(P<0.05). The multivariate Logistic regression showed that such family behavior factors as irregular breakfast(OR-boy=1.58, OR-girl=1.74), eating fast food(OR-boy=1.37, OR-girl=1.11), eating sweets(OR-boy=1.85, OR-girl=1.52), drinking sweetened beverage(OR-boy=1.64, OR-girl=1.33) and short sleep duration(OR-boy=1.56, OR-girl=1.69) were positively correlated with the prevalence of overweight/obesity in primary students. Long screen time was also correlated to overweight/obesity primary boy students(OR=1.18). Family behavior factors for child overweight and obesity induded overweight of parents(OR-boy=1.29, OR-girl=1.23) and eating sweets(OR-boy=1.44, OR-girl=1.51). Irregular breakfast(OR=1.51), eating fast food(OR=1.22), drinking sweetened beverage (OR=1.75) and long visual screen time (OR=1.15) were also positively correlated with the prevalence of overweight/obesity in junior boy students. Conclusion Family behavior factors were positively correlated with the prevalence of overweight/obesity in primary and junior students. The influence of family behavior factors were different between primary and junior students. Behavioral interventions based on family should be adopted to prevent and control the overweight/obesity of children.

Objective To evaluate the accuracy of different noninvasive methods for the diagnosis of nonalcoholic steatohepatitis(NASH) and hepatic fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus(T2DM). Method A prospective comparative study was performed for 91 patients with T2DM and NAFLD, which were diagnosed by glucose tolerance test and liver biopsy. The height and body mass of the patient were measured, and the body mass index(BMI) was calculated. The fasting venous blood of the patient was collected, and then the blood routine, liver function and ferritin were measured. NPS, neutrophil lymphocyte ratio(NLR), BARD score, FIB-4 index, APRI, and NAFLD fibrosis score(NFS) were calculated. All patients underwent transient elastography (Fibrotouch) to evaluate the degree of liver stiffness measurement (LSM) and controlled attenuation parameter. All the liver biopsy specimens were categorized by SAF as the gold standard for evaluating NASH and liver fibrosis NASH. Correlation analysis was applied to compare the correlation between the noninvasive methods and SAF. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to assess the diagnostic value of the noninvasive methods for NASH and liver fibrosis NASH. Results In T2DM combine with NAFLD patients, NPS, LSM, NFS, APRI, FIB4 and BMI scores were positively correlated with SAF (r value was 0.509, 0.508, 0.252, 0.396, 0.313 and 0.213, respectively; P value was <0.001, <0.001, 0.016,<0.001, 0.003 and 0.043, respectively). LSM, NPS, NFS and FIB4 scores were positively correlated with liver fibrosis (r value was 0.535, 0.337, 0.315 and 0.315, respectively; P value was <0.001, 0.001, 0.002, 0.002, respectively). The ROC curve shows that the area under the curve of NPS, LSM, APRI, FIB4 and BMI for diagnosing NASH was 0.838, 0.760, 0.734, 0.623 and 0.682, respectively, and P value was 0.000, 0.000, 0.000, 0.044 and 0.003, respectively. For the diagnosis of fibrotic NASH, that value of LSM, NFS, FIB4 and NPS was 0.795, 0.765, 0.686 and 0.623, respectively, and P value was 0.000, 0.001, 0.020 and 0.123, respectively. Conclusions NPS, LSM and APRI have good clinical diagnostic value for NASH. LSM and NFS have good diagnostic value for fibrotic NASH.

Objective To analyze the relationship between sleep duration, screen viewing time, and the prevalence of overweight/obesity among primary school students in Xuzhou. Methods Using a cluster sampling method, a total of 3 228 students (including 1 679 boys and 1 549 girls with an average age of 10.78±0.69 years) from grade one to six from 10 primary schools in Xuzhou underwent interview using a self?designed questionnaire containing basic characteristics, sleep duration, and screen viewing time. Data on height and weight were also collected. The relationship between sleep duration, screen viewing time, and overweight/obesity was analyzed using a logistic regression analysis. Results The prevalence rates of overweight among boys and girls were 16.56% and 11.94%, respectively (χ2=13.59, P<0.05). The prevalence rates of obesity among boys and girls were 14.47% and 10.07%, respectively (χ2=14.01, P<0.05). In total, 74.41% students reported a lack of sleep; the average sleeping time was (9.24±1.07) h. The average sleeping time among boys was (9.35 ± 1.12) h and among girls was (9.13 ± 1.03) h. The difference in sleep duration between boys and girls was significant (t=5.79, P<0.05). The differences in sleep duration and overweight/obesity were significant between both boys (χ2=18.62, P<0.05) and girls (χ2=21.14, P<0.05). Regarding screen viewing time, 17.29% of students spent more than 2 hours per day viewing a screen. The difference in screen viewing time between boys and girls was significant (Z=3.02, P=0.014). The proportion of children with screen viewing time of more than 2 h/d among overweight/obese and healthy weight male students was 29.50% (82/278) and 22.56% (316/1401), respectively, which was significantly different (χ2=6.18, P=0.01). However, there was no significant difference when examining the same groups among girls (12.98% (24/185;obese/overweight) vs . 9.97% (136/1364; healthy weight); χ2=1.59, P=0.21). After adjusting for parental obesity, eating sweets, and physical activity, logistic regression analysis showed that students who had a sleep duration less than 10 h/d had an odds ratio of 1.4 (95% CI: 1.15-1.71), the odds ratio for boys and girls was 1.56 (95% CI: 1.13-2.14) and 1.69 (95% CI: 1.15-2.46). The students who had a screen viewing time of more than 2 h/d had an odds ratio of 1.14 (95% CI: 1.05-1.80); the odds ratio for boys in this group was 1.18 (95% CI: 1.03-1.67). Conclusion Short sleep duration is a risk factor for being overweight/obese in both boys and girls. However, long screen viewing times were associated with being overweight/obese only in boys.

Background Studies have determined that nucleotide binding oligomerization domain 2 (NOD2) plays a key role in innate immune response.However,whether NOD2 participates in the nature defense of fungal keratitis is unclear.Objective This study was to investigate the expression and significance of NOD2 on cornea in the initial of Aspergillus fumigatus keratitis (AFK) in rats.Methods Seventy-two adult clean Wistar rats were randomized into the normal control group,only corneal epithelial scraped group and AFK model group,and the AFK models were established by incubating Aspergillus fumigatus to cornea after corneal epithelium was scraped.All the operations were performed in the right eyes of rats.Reverse transcription PCR (RT-PCR) was carried out to detect the expression of NOD2 mRNA in corneal epithelium 4,8,16,24 hours after operation.Twenty-four hours after operation,the expression of NOD2 protein in rat corneas was examined by immunochemistry and immnunofluorescence technology.Also,the rat corneas were obtained for regular histopathological examination.The use and care of the animals complied with Institutional Animal Care and Use Committee Guidebook by NIH.Results All the models were made successfully.RT-PCR revealed that a fewer NOD2 mRNA were expressed on cornea in the normal control group,but the expressing levels of NOD2 mRNA were increased in the only corneal epithelial scraped group and AFK model group.Compared with only corneal epithelial scraped group,the elevated values of NOD2 mRNA expression in the AFK model group were statistically significant at 4,8,16 and 24 hours after operation (t =-0.409,-0.439,-0.534,-0.618,all at P=0.000).The histopathological examination displayed that the cornel tissue had intact structure in the normal control group,and partly corneal epithelial deficiency,slight corneal swelling and fewer neutrophil granulocytes were seen in the only corneal epithelial scraped group.However,corneal ulcer,severe corneal edema and a lot of neutrophil granulocytes were exhibited in the AFK model group.Immunochemistry and immnunofluorescence staining evidenced that weaker expression of NOD2 was visualized in the corneal epithelial and endothelial layers,and obviously enhanced staining was seen in the AFK model group.The expressing levels (absorbancy) were 0.045 ± 0.005,0.050 ± 0.005 and 0.092 ± 0.006 in the normal control group,only corneal epithelial scraped group and AFK model group,respectively,showing a significant increase in the AFK model group compared with the only corneal epithelial scraped group (t =0.042,P =0.000).Conclusions Expression of NOD2 is upregulated in the corneas with AFK,suggesting that NOD2 participates the natural defense in the initial of fungal keratitis.NOD2 may play an important role in the process of anti-fungal innate immune response in cornea.

Background Fungal keratitis is a common ocular surface disease and the treatment is dissatisfactory because of short of high efficiency,low toxicity and broad-spectrum medication.Penetrating keratoplasty is an effective therapy,but its clinical applications is limited due to lack of corneal donor.To seek a low-cost and effective management is of an important significance.Objective This clinical trial was to compare the clinical effectiveness between corneal ulcer debridement combined with amniotic membrane cover+drugs therapy and corneal ulcer debridement of combined drugs therapy for fungal keratitis.Methods A prospective cases-controlled study was designed.A total 210 eyes of 210 patients with fungal keratitis were included from January 2001 to January 2013 in Affiliated Hospital of Qingdao University.The patients were randomly divided into observation group (109 eyes) and control group (101 eyes).The combination therapy of corneal ulcer debridement with amniotic membrane cover and drugs was administered in the observational group,and only lesion debridement and drugs therapy was performed on the control group.The curative effect,postoperative visual acuity and therapeutic course were compared between the two groups.Results The effective rates for fungal keratitis were 100.00％,90.41％,77.78％ in the mild,moderate and severe patients,respectively,and those of the control group were 52.38％,80.00％,25.00％ respectively,showing significant differences between them (U =2.211,2.214,2.356,all at P＜0.05).The total effective rate was significantly higher in the observational group than that in the control group (91.09％ versus 75.23％),with a significant difference between them (U=3.040,P=0.002).Postoperative visual acuity was better in the observational group than that in the control group (0.44 ± 0.04 versus 0.22 ± 0.03),with a significant difference between them (t =2.225,P ＜ 0.05).The mean therapeutic course was (22.4 ± 1.8) days in the observational group,which is shorter than (33.2±2.4) days in the control group,with a significant difference between them (t =2.097,P＜0.05).Conclusions Combination therapy of lesion debridement with amniotic membrane coverage and drugs can shorten treating duration and improve vision,and it is superior to only lesion debridement and drugs therapy.

Ophthalmic microsurgery has its own characteristics: high precision , complicated operation , and long learning curve.It is important for young ophthalmologists to master the basic operation skills through standardized and systematic training during graduate studies .The teaching method , integrating theoretical teaching , animal operation and simulative ophthalmic surgery training , have important meanings in promoting the post-graduate students to master the practical and correct ophthalmic microsurgery technique . The aim of this study was to introduce the curriculum design and practice , and to evaluate the model through the examination scores .