AIM: To compare the changes in corneal epithelial thickness(CET)after small incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS: A total of 187 patients(187 eyes)who underwent either SMILE or FS-LASIK at Urumqi Aier Eye Hospital between December 2022 and November 2023 were collected. The patients were divided into SMILE group and FS-LASIK group according to surgical methods. The CET of the patients was measured by optical coherence tomography(OCT)system before surgery and at 1 wk, 1, 3, and 6 mo postoperatively.RESULTS: Changes in corneal epithelial thickness(△CET)in the central, paracentral, and mid-peripheral regions were compared at 6 mo postoperatively. The SMILE group was characterized by the most significant thickening in the central area and the least thickening in the mid-peripheral area; while the FS-LASIK group was characterized by the most significant thickening in the paracentral area and the least thickening in the mid-peripheral region. At 1 wk, 1, 3, and 6 mo postoperatively, within the 0-7 mm corneal area, the △CET for both the SMILE and FS-LASIK groups was correlated with the preoperative spherical equivalent.CONCLUSION: Within 6 mo postoperatively, both SMILE and FS-LASIK showed a similar trend in epithelial thickening but with distinct characteristics. The change in corneal epithelial thickness for both procedures was positively correlated with the preoperative diopter.

BACKGROUND:A large number of previous studies have confirmed that a high concentration of metabolites is significantly correlated with embryo quality and clinical outcome,and the theory of silencing embryo development indicates that normally developed embryos maintain a low level of material exchange with the outside world during in vitro culture,while embryos often show abnormal metabolic activity due to stress repair mechanism when DNA damage occurs. OBJECTIVE:To establish and verify an embryo quality prediction model based on the third-day 340 nm absorbance embryo cultures to provide the basis for a more objective and accurate embryo quality assessment. METHODS:269 patients at the Nanxishan Hospital of Guangxi Zhuang Autonomous Region for in vitro fertilization and embryo transplantation from November 2019 to December 2021 were retrospectively analyzed.Among them,on day 3,162 cases who had 873 optimal embryos and 214 high-quality blastocysts were included in the high-quality embryo group.On day 3,107 cases who had 859 non-optimal embryos and 214 non-high-quality blastocysts were included in the non-high-quality embryo group.Lambert-beer law was used to screen out the characteristic wavelength with distinguishing degree between superior and non-superior embryos,analyze its correlation and influence trend with high-quality embryos,and establish the clinical prediction model and validation of absorbance for high-quality and non-high-quality embryos at this wavelength. RESULTS AND CONCLUSION:(1)There was a significant difference in absorbance between high-quality and non-high-quality embryos at 340 nm on day 3(P<0.001),and a negative correlation was found with the formation of high-quality embryos on day 3(r=-0.486,P<0.001).The absorbance of high-quality and non-high-quality blastocyst at 340 nm was significantly different(P<0.05),and was negatively correlated with the formation of high-quality blastocyst(r=-0.642,P<0.001).(2)The optimal cut-off value of absorbance at 340 nm between high-quality and non-high-quality embryos on day 3 was 0.235.The area under the curve was 0.799.Sensitivity was 62.9%.Specificity was 78.0%.Accuracy was 70.5%.The optimum cutoff value of high-quality and non-high-quality blastocysts of absorbance at 340 nm was 0.175.The area under the curve was 0.871.Sensitivity was 74.3%.Specificity was 89.1%.Accuracy was 82.2%.(3)Restricted cubic spline curve analysis showed that when the absorbance of the culture medium at 340 nm was greater than 0.221,there was a significant positive trend on the formation of non-high-quality embryos at day 3,and when the absorbance of the culture medium at 340 nm was greater than 0.160,there was a significant positive trend on the formation of non-high-quality blastocysts.(4)The clinical decision curve and clinical influence curve showed that the absorbance of the culture medium at 340 nm had the maximum clinical net benefit for the prediction models of high-quality embryos and high-quality blastocysts on the third day when the valve probability was 0.18-0.95 and 0.16-1.00,respectively,and the ratio of loss to gain within the valve probability range was always less than 1.It is proven that the prediction model has good efficacy in clinical applications.The results of embryo transfer showed that the absorbance of embryo culture medium at 340 nm in non-pregnant patients was significantly higher than that in clinical pregnancy,biochemical pregnancy and early abortion patients(P<0.05).(5)The high-quality and non-high-quality embryo culture in 340 nm absorbance has a significant difference with correlation.The embryo quality prediction model has a certain clinical value and application effectiveness.The joint embryo morphology evaluation to a certain extent improves the objectivity and accuracy of embryo quality evaluation.

BACKGROUND:The impact of the endometrium's structure and spiral artery blood flow parameters on the pregnancy rate of artificial insemination by husband remains unclear.This study identified the independent factors and constructed a prediction model with good clinical application efficacy after calibration of other confounding factors. OBJECTIVE:To construct and validate a clinical pregnancy prediction model for artificial insemination by husband based on endometrial structure and uterine spiral artery blood flow parameters. METHODS:A retrospective analysis was conducted on 1 299 patients who underwent artificial insemination by husband treatment at Changzhou Maternal and Child Health Hospital from January 2017 to January 2021.The non-pregnancy group consisted of 1 182 patients,while the pregnancy group included 117 patients.Out of these patients,93 cases were successfully matched between the pregnancy and non-pregnancy groups using a 1∶1 propensity score matching method.Single-factor and multi-factor analyses were used to screen the endometrial structure and uterine spiral artery blood flow parameters to determine their influence on artificial insemination by husband outcomes.The optimal cutoff value was established for each independent influencing factor through receiver operating curve analysis and their risk trend affecting artificial insemination by husband pregnancy outcomes was analyzed using a restricted cubic spline.The clinical efficacy of this combined forecast model was tested by using clinical decision curve and clinical influence curve methods. RESULTS AND CONCLUSION:(1)There was no statistical significance in non-endometrial factors between the pregnancy group and the non-pregnancy group,and the data had a good balance by propensity score matching(P>0.05).(2)Single-factor analysis identified several subendometrial parameters as significant influencing factors of artificial insemination by husband pregnancy outcomes,including vascularization index,flow index,vascular flow index,resistance index,pulsatility index,maximum systolic velocity/end-diastolic velocity,thickness of average junction zone and maximum junction zone from the basal endometrium to the outer myometrium inner layer(P<0.05).(3)Multivariate logistic regression analysis revealed that thickness of average junction zone,pulsatility index,and vascular flow index were independent influencing factors of pregnancy outcomes of artificial insemination by husband,vascular flow index>thickness of average junction zone>pulsatility index.(4)Receiver operating characteristic curve analysis indicated that the area under receiver operating characteristic curve of vascular flow index was 0.704(0.629,0.779),and the optimal cutoff value was 6.26;the area under receiver operating characteristic curve of thickness of average junction zone was 0.660(0.582,0.739),and the optimal cutoff value was 6.38;the area under receiver operating characteristic curve of pulsatility index was 0.642(0.563,0.721),and the optimal cutoff value was 1.18.(5)The restricted cubic spline analysis revealed that artificial insemination by husband pregnancy outcomes were significantly positively affected when the vascular flow index was>6.24 or the thickness of average junction zone was≤6.55 mm,while a negative risk was associated with pulsatility index>1.27.(6)The clinical decision curve and clinical influence curve analyses exhibited that the combined prediction model had the maximum clinical net benefit at the threshold probability value of 0.17-0.93,and the ratio of loss to benefit was consistently less than 1 in the threshold probability range,indicating that the model had good clinical efficacy.(7)It is concluded that after adjusting for other confounding factors outside of the endometrium using propensity score matching and multifactorial logistic regression,the thickness of average junction zone,pulsatility index and vascular flow index were independent factors that influenced pregnancy outcomes of artificial insemination by husband.Through determining their optimal cutoff values and assessing their risk trends,it was confirmed that the combined prediction model had good predictive value and clinical efficacy.

Objective:To investigate the current status of vocational training for pediatric clinical research coordinators (CRC), and discuss the construction of base-based pediatric CRC training, and to promote the ability of pediatric CRCs.Methods:From July 25 to October 16, 2023, an anonymous self-designed questionnaire survey was conducted through the Wenjuanxing platform to investigate the current situation of pediatric CRC vocational training and base training needs. The data were collated using Excel. Categorical data were described as numbers and percentages.Results:A total of 328 usable questionnaires were returned. Only 7.62% (25 people) believed that existing CRC training was sufficient and could meet actual work needs; 4.88% (16 people) responded that there was no training; 46.34% (152 people) believed that the training was insufficient to support actual work needs; 87.50% (287 people) believed that continuous CRC training was needed; 46.95% (154 people) preferred experienced CRCs for teaching, who should have at least 3 years of CRC work experience; and 46.95% (154 people) preferred a duration of 3 months for CRC training. The preferred training methods were: practice under the direction of experienced CRCs (90.85%, 298 people), step-by-step teaching of practical skills (88.41%, 290 people), case analysis and discussion (87.20%, 286 people), process simulation (83.23%, 273 people), and lecture-based teaching (76.52%, 251 people). The preferred post-training assessment methods were: case analysis (76.52%, 251 people), operation simulation (74.09%, 243 people), process simulation (73.17%, 240 people), written examination (66.16%, 217 people), and interview (63.72%, 209 people).Conclusions:The current pediatric CRC training is not enough to meet actual work needs. It is urgent to develop and promote a CRC training system that can meet work needs, laying the foundation for the construction of pediatric clinical research ecology in China.

Objective To systematically review and synthesize the psychological experience of kinesiophobia in patients with cardiac rehabilitation.Methods PubMed,Web of science,Journals@Ovid,Embase,CINAHL,PsycINFO,Cochrane Library,CNKI,SinoMed,WanFang Database,Vip Database,American Heart Association,European Society of Cardiology and American Association of Cardiovascular and Pulmonary Rehabilitation were searched to collect qualitative research on the psychological experience of cardiac rehabilitation patients with kinesiophobia.The retrieval time was from the establishment of the databases to Jun 2023.The literature was evaluated using the Australian JBI Quality Evaluation Criteria for Qualitative Research in Evidence-based Health Care Centres(2016),and the results were consolidated using an aggregative integration approach.Results A total of 45 results were extracted from 14 studies.Similar results were summarized into 10 groups,and 3 integrated results were synthesized as followed.Kinesiophobia was influenced by many factors;kinesiophobia affects the life experience of patients;strategies to reduce the level of kinesiophobia.Conclusion Nurses should pay more attention to psychological experience of kinesiophobia,and take the corresponding intervention measures to help patients overcome the psychological barriers of kinesiophobia,perfect personalized exercise programs,and improve the level of physical activity.

Objective:To explore the value of adenosine loaded 99Tc m-MIBI single photon emission computed tomography (SPECT) in evaluating the therapeutic effect of nicorandil on coronary microvascular angina (CMVA). Methods:Sixty eight patients diagnosed with CMVA in the Second Affiliated Hospital of Xuzhou Medical University from January 2021 to March 2022 were selected and randomly divided into a control group and a nicorandil group, with 34 patients in each group, using a random number table method. The control group received isosorbide mononitrate in addition to conventional treatment, while the nicorandil group received nicorandil in addition to conventional treatment. Both groups were treated continuously for 3 months. All patients underwent adenosine loading 99Tc m-MIBI SPECT before and after treatment to measure the degree of myocardial perfusion defect (SDS), myocardial perfusion defect area (SRS), and degree of improvement of myocardial perfusion defect (SIS). Clinical symptoms, electrocardiogram changes, myocardial enzyme indicators [cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH)], hemodynamic parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO), peripheral resistance (TPR), left ventricular work index (LVWI), and myocardial oxygen consumption (MVO 2)] were evaluated. Results:After treatment, the SDS and SRS of the nicorandil group were significantly lower than those of the control group ( P<0.01), and the SIS was significantly higher than that of the control group (all P<0.01); The improvement of abnormal myocardial perfusion imaging was significantly better than that of the control group (χ 2=4.976, P<0.05); the frequency, duration, and severity of angina attacks, Canadian Heart Association (CCS) grading, and incidence of ischemic changes on electrocardiogram were all lower than those of the control group ( P<0.01); The levels of serum cTnI, CK-MB, and LDH were significantly lower than those in the control group (all P<0.01); SBP, DBP, HR, LVWI, and MVO 2 were significantly lower than those in the control group (all P<0.01), while SV and CO were significantly higher than those in the control group (all P<0.01). Conclusions:Adenosine loaded 99Tc m-MIBI SPECT can effectively evaluate the therapeutic effect of nicorandil on CMVA, and nicorandil can improve myocardial perfusion defects and clinical manifestations in CMVA patients.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

Objective:To investigate the risk factors related to the contrast-induced nephropathy(CIN)occurring after carotid artery stenting(CAS)in patients with carotid artery stenosis.Methods:The clinical data of 137 patients with carotid artery stenosis, who were treated with CAS at Xuanwu Hospital, Capital Medical University during the period from January to Decmber 2021 were retrospectively analyzed. Record demographic characteristics (age, gender, height, weight), history of underlying diseases (hypertension, diabetes, kidney disease, etc.), history of medications, etc. Observe the clinical parameters such as creatinine, blood urea nitrogen, albumin, hemoglobin, hematocrit, degree of stenosis and estimated glomerular filtration rate (eGFR). Measurement data conforming to the normal distribution were expressed as the mean±standard deviation( ± s), and the t-test was used for comparison between groups; the measurement data that does not conform to the normal distribution were expressed as the median (interquartile range) [ M( Q1, Q3)], and the Rank-sum test was used for comparison between groups; the Chi-square test or Fisher exact test was used for comparison of count data between groups. Relevant variables were subjected to univariate analysis, and statistically significant indicators were selected according to the results of univariate analysis to be included in the multivariate Logistic regression analysis. Results:After CAS, a total of 29 patients (21.2%) among the 137 patients developed CIN. Univariate analysis indicated that bilateral carotid artery stenosis, uncontrolled hypertension before surgery, history of angiotensin converting enzyme inhibitor drugs, diabetes mellitus, history of insulin drugs, eGFR<45 mL/(min·1.73 m 2), body weight were the influencing factors associated with the occurrence of CIN after CAS in patients with carotid artery stenting; multivariate regression analysis revealed that the presence of bilateral carotid artery stenosis( OR=4.724, 95% CI: 1.455-15.338, P=0.010), diabetes mellitus( OR=3.451, 95% CI: 1.345-8.858, P=0.010) and eGFR <45 mL/(min·1.73 m 2)( OR=4.582, 95% CI: 1.001-20.971, P=0.050) were the independent risk factors related to the CIN after CAS. Conclusion:Patients with the presence of bilateral carotid artery stenosis, diabetes mellitus or eGFR <45 mL/(min·1.73 m 2) are more likely to develop CIN after CAS.

Objective:To understand the current situation and problems of pediatric drug clinical trials in China, and provide reference for the healthy development of pediatric drug clinical trials.Methods:Such keywords as " pediatrics" " children" " annual reports" " children′s drug research and development" " policies" were used, to search for information on China′s pediatric drug research and development policies and regulations, pediatric drug clinical trial institutions and pediatric drug clinical trial professional registration status, as well as pediatric drug clinical trial project registration status as of October 2023 on the drug clinical trial institution registration management information platforms and relevant government department websites. Then descriptive analysis was made on the collected information.Results:China has released 9 policies and regulations on pediatric drug research and development, supporting the development of new varieties, dosage forms, and specifications of pediatric drugs that meet the physiological characteristics of children, and giving priority review and approval to pediatric drugs. 477 drug technology guiding principles have been released, but only 14 of them were specifically designed for pediatric populations. As of March 20, 2023, there were a total of 272 registered pediatric drug clinical trial institutions, accounting for 20.72% of the total number of registered institutions. The top 5 provinces for their number of registered institutions were Guangdong province (34), Henan province (21), Zhejiang province (20), Beijing (20), and Jiangsu province (18); A total of 26 clinical trial specialties for pediatric drugs have been registered, with the largest number of registrations being pediatric respiratory (143), pediatric hematology (72), pediatrics other (71), pediatric endocrinology (68), and pediatric neurology (64). From 2020 to 2022, the proportion of pediatric drug clinical trial registration projects in newly registered drug clinical trials was 8.8% (129/1 473), 8.3% (168/2 033), and 8.3% (164/1 974), respectively, while clinical trials conducted only in the pediatric population accounted for 2.2% (33/1 473), 3.0% (61/2 033), and 3.2% (64/1 974), respectively.Conclusions:The policies and regulations on pediatric drug research and development in China still need further improvement. The number of registered pediatric drug clinical trial institutions and pediatric specialties is lower than that of adults and distributed unevenly. Clinical trial registration projects for pediatric drugs, especially those conducted in the pediatric population, account for a relatively small proportion. It is recommended to further improve the policy system for drug research and development in the pediatric population, optimize the layout of pediatric drug clinical trial institutions and specialties in the country.

Objective:To systematically evaluate the difference in the clinical effect of tunnel peripherally inserted central catheter (PICC) and non-tunnel PICC.Methods:Computer retrieval of The Cochrane Library, PubMed, Web of Science, Medline, Scopus, China National Knowledge Infrastructure (CNKI) , WanFang, VIP and China Biology Medicine disc was carried out, and the retrieval time limit was from the establishment of the database to December 31, 2021. After quality evaluation, RevMan 5.3 and Stata 15.0 were used for meta-analysis.Results:A total of 3 050 patients were included in 11 articles. Meta-analysis showed that compared with the control group, tunnel PICC could effectively reduce the incidence of catheter related infection [ OR=0.28, 95% CI (0.15, 0.52) , P<0.01], venous thrombosis [ OR=0.18, 95% CI (0.06, 0.55) , P<0.01], blood leakage [ OR=0.30, 95% CI (0.21, 0.42) , P<0.01], phlebitis [ OR=0.48, 95% CI (0.26, 0.88) , P=0.02], the ectopic rate of catheter [ OR=0.27, 95% CI (0.18, 0.41) , P<0.01], and did not increase the incidence of nerve and artery injury [ OR=0.49, 95% CI (0.10, 2.35) , P=0.37]. There were no significant differences in the incidence of catheter blockage ( OR=0.56, 95% CI: 0.20, 1.59) and medical adhesion-related skin injury ( OR=0.57, 95% CI: 0.21, 1.55) between the two groups ( P>0.05) . Conclusions:Subcutaneous tunnel technology can effectively improve the clinical effect of PICC, and has good clinical promotion value. However, high-quality and large-sample randomized controlled trials (RCTs) are still needed to be confirmed in the later stage.