Objective To compare the efficacy of controlling pediatric myopia progression between defocus incorpo-rated multiple segments(DIMS)spectacle lenses combined with low-concentration atropine(0.1 g·L-1)(DIMSA)and orthokeratology(OK)lenses.Methods A prospective cohort study was conducted on myopic children treated at the De-partment of Ophthalmology,Children's Hospital of Nanjing Medical University between January 2022 and February 2023.Participants were divided into a DIMSA group(88 cases)and an OK lens group(73 cases).Only right eye data were in-cluded for statistical analysis,and the children were followed up for 1 year.The axial length(AL)and spherical equivalent refraction(SER)were measured for the DIMSA group while only AL was measured for the OK lens group at baseline and each follow-up visit.The AL regression rate[(AL regression rate=the number of AL regression cases/total cases in the group)× 100％]and axial elongation(AE)were calculated to compare the myopia control efficacy between the two groups.Results The baseline age of the OK lens group was significantly larger than that of the DIMSA group(P=0.001).The AE value in the DIMSA group was significantly smaller than that in the OK lens group after following up for 6 months,following up for 1 year,and adjusting for baseline age(all P＜0.05).Multiple linear regression analysis revealed that baseline age was the only factor influencing the AE value[OK lens group:unstandardized β=-0.024,standardizedβ=-0.266(P=0.022);DIMSA group:unstandardized β=-0.052,standardized β=-0.487(P＜0.001)].There was a negative correlation between AE and baseline age(OK lens group:r=-0.30,P＜0.001;DIMSA group:r=-0.42,P＜0.001).In the DIMSA group,baseline age was positively correlated with SER progression(r=0.28,P=0.001 5).After following up for 1 year,the proportions of children with different AE velocities differed significantly between the two groups(x2=11.09,P=0.004).AE was controlled better in the DIMSA group than that in the OK lens group.AL regression rates in the DIMSA group were significantly higher than those in the OK lens group after 6 months and 1 year of follow-up(all P＜0.05).No severe ocular adverse events occurred in either group.Conclusion DIMSA demonstrates superior effi-cacy over OK lenses in controlling myopia progression in children with mild-to-moderate myopia.Ophthalmologists should tailor myopia control strategies based on individual needs and characteristics.

Objective:To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia（MRMPP）.Methods:A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae，patients were divided into three groups：Doxycycline group（those treated with doxycycline，12 cases）；Azithromycin group（those treated with azithromycin，53 cases）；and Switch group（those switched from azithromycin to doxycycline，27 cases）.Clinical outcomes and adverse reactions were compared among the three groups.Results:Significant statistical differences were found among the three groups in terms of age（ F=49.365， P<0.001）and weight（ H=40.595， P<0.001），with the Doxycycline group presenting the highest average age and median weight，followed by the Switch group，and then the Azithromycin group.After antibiotic treatment，children in the Doxycycline group，when compared to the Switch group and the Azithromycin group，showed a shorter fever resolution time[3.0（2.0，3.8）days vs.5.0（4.0，5.0）days vs.6.0（5.0，7.0）days， H=25.243， P<0.001]，a higher defervescence rate at 48 hours and 72 hours (41.7% vs.0 vs.0 at 48 hours，and 75.0% vs.0% vs.5.7% at 72 hours，both P<0.001]，a shorter mechanical ventilation duration[83.0（70.0，93.0）hours vs.135.0（129.0，172.0）hours vs.152.0（139.0，164.5）hours， H=9.980， P=0.007]，a shorter ICU stay[7.0（6.0，8.0）days vs.10.0（8.0，13.0）days vs.11.0（9.0，13.0）days， H=21.887， P<0.001]，and a lower proportion of Methylprednisolone usage [8.3% vs.57.1% vs.54.7%， P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens（both P>0.05）.Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin，with rates of 10.3%（4/39）and 13.8%（11/80）,respectively，showing no statistical significance（ P=0.771）.Among the 67（72.8%）cases with available follow-up data，the incidence of bronchiolitis obliterans was 8.3%（1/12）in the Doxycycline group，13.6%（3/22）in the Switch group，and 15.2%（5/33）in the Azithromycin group，with no statistical significance（ P>0.05）.Among the 34 cases using doxycycline with follow-up data available，none had tooth discoloration or enamel hypoplasia related to the medication. Conclusion:Doxycycline in the treatment of severe MRMPP in children could rapidly improve clinical symptoms，shorten the course of the disease，reduce the likelihood of methylprednisolone use，and is relatively safe for short-term use.

Objective:To investigate the myopia progression in Chinese young medical college students and explore the associated risk factors.Methods:A cohort study was conducted.Among 1 068 freshmen aged 16 to 22 years receiving health checkups at a medical university in Tianjin, 979 myopes were ultimately included in the baseline assessment and 812 participated in the follow-up assessment after two years.The anterior segment examination with a slit lamp, non-cycloplegic autorefraction with an autorefractor and axial length (AL) measurements with Lenstar 900 were performed on participants at baseline and during the two-year follow-up.Myopia progression was defined as a spherical equivalent (SE) change of ≤-0.50 D/year or an AL increase of ≥0.20 mm/year.Multivariate regression analysis with the generalized estimating equation model was employed to identify risk factors associated with myopia progression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2021KY-16).Informed consent was obtained from each subject.Results:During the two-year follow-up, 92.5%(751/812) of the participants had stable SE and 96.1%(764/795) had stable AL.However, 7.5%(61/812) showed SE progression and 3.9%(31/795) exhibited AL growth, demonstrating a tendency of myopia progression.Multivariate linear regression analysis revealed that females ( β=0.064, 95% CI: 0.002~0.126; P=0.042) and low to moderate myopia at baseline ( β=0.083, 95% CI: 0.005~0.161; P=0.037) were significantly associated with AL growth compared to high myopia at baseline. Conclusions:More than 92% of young college students have stable myopia.In addition to high myopia, there is still a need for better follow-up and management of females and those with low to moderate myopia to control the high prevalence of high myopia.

Objective:To compare the changes in spherical equivalent (SE) and axial length (AL) between children with axial myopia and refractive myopia.Methods:A prospective cohort study was conducted.A total of 1 738 students from grades 1 to 6 were recruited from two consistent 9-year schools in the Binhai New Area of Tianjin using cluster random sampling.Visual acuity, refractive status, and ocular biological parameters were measured from February to May in 2018 and 2021.Participants were categorized into subgroups as follows: low, moderate, and high myopia based on SE; longer AL group and shorter AL groups based on AL; and steeper cornea and flatter cornea groups based on corneal curvature radius (CCR). Myopic children were further classified into the following groups: axial myopia (longer AL and flatter cornea), refractive myopia (shorter AL and steeper cornea), mixed myopia (longer AL and steeper cornea), and non-axial non-refractive myopia (shorter AL and flatter cornea). Changes in SE (ΔSE) and AL (ΔAL) at the end of the follow-up period were compared among the different classification groups.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY-39). Written informed consent was obtained from the guardians of all participants.Results:The ΔSE in the longer AL group was (-1.57±1.52)D, which was significantly greater than (-1.17±1.47)D in the shorter AL group ( t=3.99, P<0.01). The ΔAL in the steeper cornea group was (0.92±0.50)mm, which was significantly greater than (0.86±0.54)mm in the flatter cornea group ( t=-2.12, P=0.04). Among children aged 10-12 years, males, and the low myopia, SE progression was faster in those with longer AL compared to shorter AL, with statistically significant differences ( t=2.66, 3.31, 3.90; all P<0.05). In children aged 10-12 years, AL growth was faster in the longer AL group than in the shorter AL group, with a statistically significant difference ( t=-1.29, P=0.04). Among females and the low myopia, AL growth was faster in those with steeper corneas than in those with flatter corneas, with statistically significant differences ( t=-3.22, -2.43; both P<0.05). Refractive myopia had a smaller ΔSE than axial myopia and the difference was statistically significant ( P<0.05). Within the low myopia, SE progression was greater in axial myopia than in refractive myopia, with a statistically significant difference ( P<0.05). Conclusions:Among myopic children, those with longer axial lengths exhibit faster SE progression, while those with steeper corneas show faster axial elongation.Among children with low myopia, axial myopia is associated with a greater risk of SE progression than refractive myopia.

Objective:To evaluate the efficacy of early bronchoalveolar lavage using electronic bronchoscopy in pediatric drowning cases.Methods:A retrospective analysis of clinical data from 81 pediatric drowning cases treated in the intensive care unit of Hunan Children's Hospital from January 2017 to September 2023 was conducted.Among these,43 cases underwent bronchoalveolar lavage with electronic bronchoscopy within 24 hours of drowning,constituting the treatment group,while 38 cases either did not receive treatment within 24 hours or underwent the procedure after 24 hours,forming the control group.We compared the two groups regarding pre-admission observations,admission observations,and disease progression or prognosis indicators to assess the clinical efficacy of early bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases.Results:Compared to the control group,children in the treatment group exhibited a significant reduction in invasive ventilation time [(73.33±13.33) h vs.(94.82±15.77) h] and a significant decrease in pediatric intensive care unit stay [105.00 (94.00,121.00) h vs.123.5 (109.75,149.00) h],with both differences being statistically significant( P<0.05).No significant differences in white blood cell count and neutrophil percentage were observed between the treatment group and control group at admission and on the first day( P>0.05).However,by the third day,there was a significant improvement in white blood cell count in both groups,with statistical significance( P<0.05).There was a significant decrease in C-reactive protein and procalcitonin levels between the treatment group and control group on the 1st and 3rd days,with the differences being significant( P<0.05).Six hours after electronic bronchoalveolar lavage,the P/F ratio in the treatment group was lower than that in the control group (177.09±41.27 vs. 233.50±48.23),but it increased more significantly at 24 hours (286.00±34.32 vs.256.34±44.22),with a significant difference between two groups.The positive rate of lavage fluid culture in the treatment group was significantly higher than that in the control group,and the difference was statistically significant( P<0.05).There was no significant difference in the number of organ function damage between two groups( P>0.05).However,regarding prognosis,the treatment group showed significantly better outcomes than the control group( P<0.05). Conclusion:For pediatric patients with wilderness drowning,early electronic bronchoscopy with alveolar lavage may shorten the duration of invasive mechanical ventilation and pediatric intensive care unit stay,improving prognosis,and is worth promoting.

Objective:To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia（MRMPP）.Methods:A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae，patients were divided into three groups：Doxycycline group（those treated with doxycycline，12 cases）；Azithromycin group（those treated with azithromycin，53 cases）；and Switch group（those switched from azithromycin to doxycycline，27 cases）.Clinical outcomes and adverse reactions were compared among the three groups.Results:Significant statistical differences were found among the three groups in terms of age（ F=49.365， P<0.001）and weight（ H=40.595， P<0.001），with the Doxycycline group presenting the highest average age and median weight，followed by the Switch group，and then the Azithromycin group.After antibiotic treatment，children in the Doxycycline group，when compared to the Switch group and the Azithromycin group，showed a shorter fever resolution time[3.0（2.0，3.8）days vs.5.0（4.0，5.0）days vs.6.0（5.0，7.0）days， H=25.243， P<0.001]，a higher defervescence rate at 48 hours and 72 hours (41.7% vs.0 vs.0 at 48 hours，and 75.0% vs.0% vs.5.7% at 72 hours，both P<0.001]，a shorter mechanical ventilation duration[83.0（70.0，93.0）hours vs.135.0（129.0，172.0）hours vs.152.0（139.0，164.5）hours， H=9.980， P=0.007]，a shorter ICU stay[7.0（6.0，8.0）days vs.10.0（8.0，13.0）days vs.11.0（9.0，13.0）days， H=21.887， P<0.001]，and a lower proportion of Methylprednisolone usage [8.3% vs.57.1% vs.54.7%， P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens（both P>0.05）.Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin，with rates of 10.3%（4/39）and 13.8%（11/80）,respectively，showing no statistical significance（ P=0.771）.Among the 67（72.8%）cases with available follow-up data，the incidence of bronchiolitis obliterans was 8.3%（1/12）in the Doxycycline group，13.6%（3/22）in the Switch group，and 15.2%（5/33）in the Azithromycin group，with no statistical significance（ P>0.05）.Among the 34 cases using doxycycline with follow-up data available，none had tooth discoloration or enamel hypoplasia related to the medication. Conclusion:Doxycycline in the treatment of severe MRMPP in children could rapidly improve clinical symptoms，shorten the course of the disease，reduce the likelihood of methylprednisolone use，and is relatively safe for short-term use.

Objective:To investigate the myopia progression in Chinese young medical college students and explore the associated risk factors.Methods:A cohort study was conducted.Among 1 068 freshmen aged 16 to 22 years receiving health checkups at a medical university in Tianjin, 979 myopes were ultimately included in the baseline assessment and 812 participated in the follow-up assessment after two years.The anterior segment examination with a slit lamp, non-cycloplegic autorefraction with an autorefractor and axial length (AL) measurements with Lenstar 900 were performed on participants at baseline and during the two-year follow-up.Myopia progression was defined as a spherical equivalent (SE) change of ≤-0.50 D/year or an AL increase of ≥0.20 mm/year.Multivariate regression analysis with the generalized estimating equation model was employed to identify risk factors associated with myopia progression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2021KY-16).Informed consent was obtained from each subject.Results:During the two-year follow-up, 92.5%(751/812) of the participants had stable SE and 96.1%(764/795) had stable AL.However, 7.5%(61/812) showed SE progression and 3.9%(31/795) exhibited AL growth, demonstrating a tendency of myopia progression.Multivariate linear regression analysis revealed that females ( β=0.064, 95% CI: 0.002~0.126; P=0.042) and low to moderate myopia at baseline ( β=0.083, 95% CI: 0.005~0.161; P=0.037) were significantly associated with AL growth compared to high myopia at baseline. Conclusions:More than 92% of young college students have stable myopia.In addition to high myopia, there is still a need for better follow-up and management of females and those with low to moderate myopia to control the high prevalence of high myopia.

Objective:To compare the changes in spherical equivalent (SE) and axial length (AL) between children with axial myopia and refractive myopia.Methods:A prospective cohort study was conducted.A total of 1 738 students from grades 1 to 6 were recruited from two consistent 9-year schools in the Binhai New Area of Tianjin using cluster random sampling.Visual acuity, refractive status, and ocular biological parameters were measured from February to May in 2018 and 2021.Participants were categorized into subgroups as follows: low, moderate, and high myopia based on SE; longer AL group and shorter AL groups based on AL; and steeper cornea and flatter cornea groups based on corneal curvature radius (CCR). Myopic children were further classified into the following groups: axial myopia (longer AL and flatter cornea), refractive myopia (shorter AL and steeper cornea), mixed myopia (longer AL and steeper cornea), and non-axial non-refractive myopia (shorter AL and flatter cornea). Changes in SE (ΔSE) and AL (ΔAL) at the end of the follow-up period were compared among the different classification groups.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY-39). Written informed consent was obtained from the guardians of all participants.Results:The ΔSE in the longer AL group was (-1.57±1.52)D, which was significantly greater than (-1.17±1.47)D in the shorter AL group ( t=3.99, P<0.01). The ΔAL in the steeper cornea group was (0.92±0.50)mm, which was significantly greater than (0.86±0.54)mm in the flatter cornea group ( t=-2.12, P=0.04). Among children aged 10-12 years, males, and the low myopia, SE progression was faster in those with longer AL compared to shorter AL, with statistically significant differences ( t=2.66, 3.31, 3.90; all P<0.05). In children aged 10-12 years, AL growth was faster in the longer AL group than in the shorter AL group, with a statistically significant difference ( t=-1.29, P=0.04). Among females and the low myopia, AL growth was faster in those with steeper corneas than in those with flatter corneas, with statistically significant differences ( t=-3.22, -2.43; both P<0.05). Refractive myopia had a smaller ΔSE than axial myopia and the difference was statistically significant ( P<0.05). Within the low myopia, SE progression was greater in axial myopia than in refractive myopia, with a statistically significant difference ( P<0.05). Conclusions:Among myopic children, those with longer axial lengths exhibit faster SE progression, while those with steeper corneas show faster axial elongation.Among children with low myopia, axial myopia is associated with a greater risk of SE progression than refractive myopia.

Objective To compare the postoperative enhanced recovery outcomes of lobectomy performed under non-intubated video-assisted thoracic surgery (NIVATS) versus intubated video-assisted thoracic surgery (IVATS). Methods Computerized searches were performed in the following databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Information, China Biomedical Literature Database (CBMdisc), Web of Science, Clinicaltrials.gov, The Cochrane Library, EMbase, and PubMed. We collected randomized controlled trials (RCTs) and observational studies comparing NIVATS and IVATS. The search period extended from the inception of each database to April 1, 2023. Two independent researchers screened the literature and assessed study quality. Results A total of 14 studies were included, comprising 4 RCTs, 7 retrospective cohort studies, and 3 propensity score matching studies, involving 1 840 patients. Meta-analysis results indicated that, compared to IVATS, NIVATS was associated with significantly shorter operative time [MD=–13.39, 95%CI (–20.16, –6.62), P<0.001], shorter length of hospital stay [MD=–0.81, 95%CI (–1.39, –0.22), P=0.005], shorter chest tube duration [MD=–0.73, 95%CI (–1.36, –0.10), P=0.02], shorter postoperative anesthesia recovery time [MD=–20.34, 95%CI (–26.83, –13.84), P<0.001], and shorter time to oral intake after surgery [MD=–5.68, 95%CI (–7.63, –3.73), P<0.001]. Furthermore, NIVATS showed a lower incidence of postoperative airway complications [OR=0.49, 95%CI (0.34, 0.71), P<0.001] and less total chest tube drainage volume [MD=–251.11, 95%CI (–398.25, –103.98), P<0.001], all contributing to significantly accelerated postoperative enhanced recovery for patients. Conclusion NIVATS is a safe and technically feasible anesthesia method in thoracoscopic lobectomy, which can to some extent replace IVATS.

Objective: To explore the relationship of physical activity (PA) and sedentary behavior (SB) with cardiorespiratory fitness (CRF) among middle schoold students in Tibet, so as to provide empirical references for improving the cardiorespiratory fitness and health levels of adolescents in Tibet. Methods: From August to December 2020, 1 225 junior and senior high school students were selected from 2 middle schools in Lhasa, Tibet Autonomous Region, using the stratified cluster random sampling method. Triaxial accelerometers were used to evaluate PA and SB behaviors, and the 20 meter shuttle run was employed to assess CRF among the middle school students. Isochronous substitution modeling was used to analyze the associations of SB, low intensity physical activity (LPA), and moderate vigorous physical activity (MVPA) with CRF, and the saturation threshold effect in the dose response relationship between MVPA and CRF was analyzed through restricted cubic spline and two stage linear regression. Results: After adjusting for covariates such as gender, body mass index and sleep quality score, isotemporal substitution analysis showed that among junior high school students aged 13-15, replacing 30 minutes of SB ( B =1.73) or LPA ( B =2.38) with MVPA were positively associated with CRF (both P <0.05). Among senior high school students aged 16-18, replacing SB ( B =0.99) or LPA ( B =1.38) with MVPA were also positively associated with CRF (both P <0.05). Restricted cubic spline and two piecewise linear regression analyses indicated that only middle school girls aged 13-18 exhibited a saturation threshold effect between MVPA and CRF (logarithmic likelihood ratio test=0.03), with the optimal CRF improvement observed at 60 minutes of MVPA per day ( B=0.13, P ＜ 0.01). Conclusions Reducing SB and LPA while increasing MVPA can improve CRF in Tibetan middle school students. To maximize CRF improvement, middle school girls should engage in at least 60 minutes of MVPA daily.