Myopia prevention and control holds significant importance for the cultivation of strategic talents at the national level. In recent years, myopia among Chinese students has shown a trend of increasing prevalence and earlier onset. Once myopia develops, it is difficult to reverse. Schools, as the primary setting for student learning and activities, play a crucial role in mitigating the high incidence of myopia among students. This article provides a review of the progress in school-based myopia prevention and control interventions both domestically and internationally, with a focus on visual tracking exercises, outdoor light exposure, and improvements to classroom lighting environments. The study finds that methods such as visual tracking exercises, outdoor light exposure, and classroom lighting improvement can effectively prevent students from developing myopia and control the progression of myopia. The findings may offer scientific evidence for further improving policy formulation in China.

OBJECTIVE: To develop and validate a predictive model for the risk of bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). METHODS: A literature search was conducted in PubMed, Cochrane Library, and Embase databases from inception to July 2022 to identify studies reporting statistically significant risk factors for CRKP-BSI. Relative risks (RR) were extracted and pooled. Based on factor weights, a risk-scoring model was established. For external validation, hospitalized CRKP-infected patients from January 2016 to January 2022 at Shanghai First People's Hospital were included. Clinical data were used to calculate individual risk scores. The predictive accuracy was assessed using receiver operator characteristic curve (ROC curve). Patients were stratified into low-to-intermediate-risk and high-risk groups based on the optimal cut-off, and CRKP BSI incidence was compared between groups. RESULTS: The literatures related to the risk factors of CRKP-BSI published from database inception to July 2022 was retrieved and screened from PubMed, Cochrane Library, and Embase. Fourteen risk factors were included in the scoring model: cardiovascular disease, severe neutropenia or immunosuppression, intensive care unit (ICU) stay history, prior hospitalization, carbapenem exposure, aminoglycoside exposure, antifungal exposure, endotracheal intubation or tracheostomy, mechanical ventilation, hemodialysis, central venous catheter, indwelling urinary catheter, CRKP colonization, and Klebsiella pneumoniae positivity at non infection sites. The total score ranged from 0 to 173.5 points. In the validation cohort of 230 CRKP-infected patients, 41 developed CRKP BSI. The model yielded an area under the curve (AUC) of 0.783 (95%CI was 0.689-0.876). The optimal cut off was 81.25 points, with sensitivity of 75.6% and specificity of 81.0%. Based on this cut off, 163 patients were categorized as low-to-intermediate risk and 67 patients as high risk. The incidence of CRKP BSI in the high-risk group was significantly higher than in the low-to-intermediate-risk group [64.2% (43/67) vs. 4.9% (8/163); RR = 13.175 (95%CI was 5.920-29.319), P < 0.001]. CONCLUSIONS The model, based on 14 routinely available clinical parameters, demonstrated good performance in predicting CRKP BSI risk and may assist clinicians in early identification of high risk patients.
Humans ; Klebsiella pneumoniae/drug effects* ; Klebsiella Infections/microbiology* ; Carbapenems/pharmacology* ; Risk Factors ; Bacteremia/microbiology* ; ROC Curve ; Carbapenem-Resistant Enterobacteriaceae

Objective To compare the safety and efficacy of vancomycin in obese patients guided by trough concentration and AUC24h/MIC,and to provide data for individualized administration of vancomycin in obese patients.Methods We retrospectively collected the data of obese adult patients(BMI 30 kg/m2)who had severe infection caused by gram-positive cocci and treated with vancomycin intravenously in two Grade A tertiary hospitals in Shanghai from 2012 to 2024.The patients were assigned to trough concentration monitoring group or AUC24h/MIC monitoring group according to the therapeutic drug monitoring(TDM)method at the time of admission.Nephrotoxicity and efficacy were compared between the two groups of patients.Results A total of 22 obese patients were included in this study,including 12 in the trough concentration monitoring group and 10 in the AUC24h/MIC monitoring group.No significant difference was found between the two groups in gender,age,BMI,creatinine clearance before treatment,underlying disease,site of infection,pathogen type,or concomitant medications.The proportion of ICU admission was higher in AUC24h/MIC monitoring group.The length of ICU stay,vancomycin treatment duration,bacterial clearance rate and comprehensive efficacy rate did not show significant difference between the two groups.The average daily dose of vancomycin in trough concentration monitoring group was significantly lower than that in A UC24h/MIC monitoring group[(1.63±0.59)g vs(2.29±0.72)g,P=0.026].The average treatment duration was not significantly different between the two groups[(15.33±10.28)d vs(14.90±6.92)d,P=0.911].Compared with the trough concentration monitoring group,the initial peak concentration[(30.99±16.22)mg/L vs(19.41±5.42)mg/L,P=0.025]and overall peak concentration[(33.67±16.53)mg/L vs(22.08±3.96)mg/L,P=0.045]of vancomycin were lower in theAUC24h/MIC monitoring group,but the initial trough concentration[(11.03±8.66)mg/L vs(6.33±4.45)mg/L,P=0.139]and overall trough concentration[(13.75±9.74)mg/L vs(9.74±4.24)mg/L,P=0.218]were similar in the two groups.Vancomycin-associated nephrotoxicity did not occur in any group,but 41.7％of the patients in the trough concentration monitoring group reached the threshold of renal toxicity,i.e.trough concentration ≥15 mg/L.Conclusions Vancomycin treatment with conventional dosing regimen still have good clinical efficacy in obese adult patients.Vancomycin therapy guided by A UC24h/MIC can achieve the target value at lower concentration or exposure,which is promising for reducing vancomycin-associated nephrotoxicity.

Objective To compare the safety and efficacy of vancomycin in obese patients guided by trough concentration and AUC24h/MIC,and to provide data for individualized administration of vancomycin in obese patients.Methods We retrospectively collected the data of obese adult patients(BMI 30 kg/m2)who had severe infection caused by gram-positive cocci and treated with vancomycin intravenously in two Grade A tertiary hospitals in Shanghai from 2012 to 2024.The patients were assigned to trough concentration monitoring group or AUC24h/MIC monitoring group according to the therapeutic drug monitoring(TDM)method at the time of admission.Nephrotoxicity and efficacy were compared between the two groups of patients.Results A total of 22 obese patients were included in this study,including 12 in the trough concentration monitoring group and 10 in the AUC24h/MIC monitoring group.No significant difference was found between the two groups in gender,age,BMI,creatinine clearance before treatment,underlying disease,site of infection,pathogen type,or concomitant medications.The proportion of ICU admission was higher in AUC24h/MIC monitoring group.The length of ICU stay,vancomycin treatment duration,bacterial clearance rate and comprehensive efficacy rate did not show significant difference between the two groups.The average daily dose of vancomycin in trough concentration monitoring group was significantly lower than that in A UC24h/MIC monitoring group[(1.63±0.59)g vs(2.29±0.72)g,P=0.026].The average treatment duration was not significantly different between the two groups[(15.33±10.28)d vs(14.90±6.92)d,P=0.911].Compared with the trough concentration monitoring group,the initial peak concentration[(30.99±16.22)mg/L vs(19.41±5.42)mg/L,P=0.025]and overall peak concentration[(33.67±16.53)mg/L vs(22.08±3.96)mg/L,P=0.045]of vancomycin were lower in theAUC24h/MIC monitoring group,but the initial trough concentration[(11.03±8.66)mg/L vs(6.33±4.45)mg/L,P=0.139]and overall trough concentration[(13.75±9.74)mg/L vs(9.74±4.24)mg/L,P=0.218]were similar in the two groups.Vancomycin-associated nephrotoxicity did not occur in any group,but 41.7％of the patients in the trough concentration monitoring group reached the threshold of renal toxicity,i.e.trough concentration ≥15 mg/L.Conclusions Vancomycin treatment with conventional dosing regimen still have good clinical efficacy in obese adult patients.Vancomycin therapy guided by A UC24h/MIC can achieve the target value at lower concentration or exposure,which is promising for reducing vancomycin-associated nephrotoxicity.

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Purpose To explore the value of gray-scale ultrasound and contrast-enhanced ultrasound of carotid plaques combined with clinical factors in predicting the recurrence risk of ischemic stroke(IS)in patients with mild to moderate carotid stenosis.Materials and Methods A total of 101 patients with mild to moderate carotid artery stenosis who were initially diagnosed with IS in the First Medical Center of the Chinese PLA General Hospital were prospectively collected from May 2022 to August 2023.After one year of follow-up,patients were divided into recurrent group(n=33)and non-recurrent group(n=68)according to whether new IS occurred.The characteristics of plaque ultrasound and the clinical information of patients were compared between the two groups.A multivariate Logistic prediction model was established and its efficacy was evaluated.Results The results of multivariate analysis showed that low-density lipoprotein cholesterol(OR=2.116,P=0.046),C-reactive protein(OR=3.707,P=0.008),plaque internal echo(OR=7.410,P=0.029)and intraplaque neovascularization grading 3(OR=17.155,P=0.030)were independent risk factors for the recurrence of IS.The area under the curve of the model established using the above indicators was 0.825,the sensitivity and specificity were 87.50%and 65.15%,respectively.Conclusion The ultrasound features of carotid plaque are closely related to recurrent IS,which can provide an important basis for the clinical treatment of patients with mild-moderate carotid artery stenosis complicated with IS.

Purpose To explore the value of gray-scale ultrasound and contrast-enhanced ultrasound of carotid plaques combined with clinical factors in predicting the recurrence risk of ischemic stroke(IS)in patients with mild to moderate carotid stenosis.Materials and Methods A total of 101 patients with mild to moderate carotid artery stenosis who were initially diagnosed with IS in the First Medical Center of the Chinese PLA General Hospital were prospectively collected from May 2022 to August 2023.After one year of follow-up,patients were divided into recurrent group(n=33)and non-recurrent group(n=68)according to whether new IS occurred.The characteristics of plaque ultrasound and the clinical information of patients were compared between the two groups.A multivariate Logistic prediction model was established and its efficacy was evaluated.Results The results of multivariate analysis showed that low-density lipoprotein cholesterol(OR=2.116,P=0.046),C-reactive protein(OR=3.707,P=0.008),plaque internal echo(OR=7.410,P=0.029)and intraplaque neovascularization grading 3(OR=17.155,P=0.030)were independent risk factors for the recurrence of IS.The area under the curve of the model established using the above indicators was 0.825,the sensitivity and specificity were 87.50%and 65.15%,respectively.Conclusion The ultrasound features of carotid plaque are closely related to recurrent IS,which can provide an important basis for the clinical treatment of patients with mild-moderate carotid artery stenosis complicated with IS.

Objective:To evaluate the prevalence of euthyroid sick syndrome(ESS)in sepsis patients and to explore its influencing factors.Methods:In the study,365 patients diagnosed with sepsis in the emergency critical care department of Shanghai First People's Hospital from January 2017 to January 2023 were retrospectively enrolled.The patients were divided into ESS and non-ESS groups based on whether the patients were complicated with ESS.Baseline variables and relevant clinical data of the enrolled pa-tients were collected.The prevalence of ESS in sepsis patients and its influencing factors were evaluated by multivariate Logistic regression analysis,and the 30-day survival rates were compared between the two groups.The optimal cutoff value for free triiodothyronine(FT3)was explored to predict death in the pa-tients with sepsis.Results:There were 103 sepsis patients with ESS,accounting for 28.2％of the total cases.The severity of sepsis in ESS group was significantly higher than that in non-ESS group(P＜0.05).The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score of ESS group were significantly higher than those of non-ESS group(P＜0.05).C-reactive protein(CRP),procalcitonin(PCT),serum amyloid A(SAA)and interleu-kin-6(IL-6)in ESS group were higher than those in non-ESS group.total cholesterol(TC)and high-den-sity liptein cholesterol(HDL-C)in ESS group were lower than those in non-ESS group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that PCT,IL-6,CRP,SAA and activated partial thromboplatin time(APTT)were independent risk factors for ESS in the sepsis patients(OR values were 1.105,1.006,1.005,1.009 and 1.033,respectively;95％CI were 1.044-1.170,1.001-1.012,1.001-1.009,1.005-1.014,1.004-1.062,respec-tively,P＜0.05).The 30-day survival rate in ESS group was significantly lower than that in non-ESS group,the Long-rank chi-square test value was 16.611,and the difference was statistically significant(P＜0.05).The receiver operation characteristic area under the curve(AUCROC)of FT3 predicted death in the patients with sepsis was 0.924(95％CI 0.894-0.954).The serum FT3 cutoff point was 3.705 pmol/L,the specificity was 0.868,and the sensitivity was 0.950.Conclusion:In this study,the inci-dence of ESS in sepsis patients was determined to be 28.2％with poor prognosis.The results showed that PCT,IL-6,CRP,SAA and APTT were independent risk factors for ESS in sepsis patients,while HDL-C was a protective factor(P＜0.05).FT3 is a novel potential biomarker for predicting death in patients with sepsis.

【Objective】 To investigate and analyze the serological and molecular biological characteristics of B(A) subgroup in a tertiary hospital in Jiaozhou, Qingdao. 【Methods】 From November 2019 to February 2023, the samples of 12 patients were suspected to be AB subgroup by microcolumn glass bead method and saline test tube method. The exons 6 and 7 of ABO gene were further amplified, sequenced and analyzed to determine the ABO allele type. 【Results】 A total of 9 cases of B(A) subgroup were detected in 26 065 patients in Jiaozhou, with a detection rate of 0.345 ‰ ( 9/26 065 ). Among the 9 cases of B(A) subgroup, 8 cases of serological reaction showed AweakB, and the gene detection was heterozygous for BA.04 gene and O gene.One case of serological reaction showed ABweak, and the gene detection was heterozygous for BA.04 gene and A gene. 【Conclusion】 Blood group serological combined with gene detection can accurately identify ABO blood group. B(A) subgroup alleles can exist in individuals with serological reaction of ABweak.