With the rapid advancement of modern medicine, clinical observations indicate a growing trend of ischemic ocular disease with an increasingly younger age of onset. This condition remains a prominent and challenging focus in ophthalmic clinical practice. Treatment approaches focused solely on ophthalmic interventions yield less than satisfactory clinical outcomes. Some ischemic ocular disease patients concurrently suffer from obstructive sleep apnea hypopnea syndrome(OSAHS). These patients show rapid Ischemic ocular disease progression, difficulty in stabilizing blood pressure, and increased susceptibility to cardiovascular and cerebrovascular events during ophthalmic treatment. This review primarily examines the correlation between ischemic ocular disease and OSAHS, the pathophysiological changes in ischemic ocular disease patients and the risk factors in OSAHS patients. It aims to provide a theoretical basis for clinical management and disease prevention in this patient population.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective: To explore the influence of birthweight and delivery mode on overweight/obesity and abdominal obesity in primary school students, and to provide evidence for childhood obesity prevention. Methods: After physical examination, questionnaire survey was conducted among 3 361 students and their parents from 3 primary schools in Guangzhou selected through stratified clustering sampling. Information about birthweight and delivery mode was collected. Logistic regression model was used to analyze the association of birthweight and delivery mode with overweight/obesity and abdominal obesity. The multiplicative interaction term and the Delta method was used to explore the potential interaction. Results: The prevalence rate of overweight and obesity for primary school students was 21.33%, and the rate of abdominal obesity was 12.08%. Multivariate Logistic regression analysis showed that delivery by cesarean section was associated with 44% increased risk of overweight/obesity(OR=1.44, 95%CI=1.16-1.80), as compared to vaginal delivery. Higher birthweight was linked to increased risk of overweight/obesity(OR=1.62, 95%CI=1.09-2.42). There was no significant association of birth weight and delivery mode with abdominal obesity in multivariate analysis(P>0.05). Additionally, a positive additive interaction was seen between delivery mode and parental obesity for students risk of overweight/obesity(RERI=0.33, 95%CI=0.02-0.65), as well as for the risk of abdominal obesity(RERI=0.39, 95%CI=0.12-0.65). Conclusion Cesarean section delivery and higher birthweight are linked to increased risk of overweight and obesity in primary school students. The synergistic effect of cesarean section and parental obesity may increase the risk of childhood obesity.

Objective:To analyze the current status of body composition and development patterns of children and adolescents aged 6-17 years in Guangzhou.Methods:This was a cross-sectional study involving 8 169 school students from 3 elementary schools and 3 middle schools in Guangzhou from March to December 2019.The fat-free mass (FFM) and fat mass (FM) were measured by the bioelectrical impedance analysis.The fat-free mass index (FFMI) and fat mass index (FMI) were calculated via the height standardization. T test was used to compare quantitative variables between groups.The growth pattern of body composition was described using the Hattori chart. Results:A total of 4 431 boys (54.24%) and 3 738 girls (45.76%) were involved in this study.FFM and FM both increased with age between boys and girls.Except for boys aged 11 years, FFM in boys were significantly higher than that in girls with the same age (all P<0.05). In the age of 7-10 years, FM in boys were significantly higher than that in girls with the same age, while it was significantly higher in girls aged 12 years and older than that of boys at the same age (all P<0.05). The Hattori chart showed that the difference in body composition between genders occurred after 11 years old.In contrast to girls, increases in the weight and body mass index (BMI) in boys were mainly attributed to the FFM development. Conclusions:The development of FFM and FM in children and adolescents varies with age, accompanied with the gender-specific features.FFM in boys is higher than that of girls at the same age.The weight gain in boys is mainly attributed to the development of fat-free tissues, and thus the utility of BMI may lead to the overestimation of obesity.

Objective:To evaluate the consistency between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in the measurement of body composition in children and adolescents aged 7-17 years.Methods:Fat-free mass (FFM) and fat mass (FM) were measured by both BIA and DXA in 1 431 children. The consistency between the methods was evaluated by intra-class correlation coefficients (ICCs) and Bland-Altman analysis. Logarithmic transformation of both measurements was performed before Bland-Altman analysis.Results:The ICCs for FFM were 0.986 and 0.974 and ICCs for FM were 0.854 and 0.926 in boys and girls respectively. In boys, the mean ratio of FFMs by BIA and DXA was 1.04, with limits of Agreement (LoA) of 0.95-1.14, and in girls, the mean ratio of FFMs by BIA and DXA was 1.02, with the LoA of 0.90-1.15. The LoA of FFM became narrower with age in both boys and girls. Both boys and girls had the wide LoAs for FM (0.40-1.27 and 0.48-1.48, respectively). Additionally, the LoA ranges for FFM and FM narrowed with the increase of BMI level in both boys and girls.Conclusion:For all children, BIA showed good consistency with DXA for FFM, whereas significant errors occurred in FM measurement. The consistency between BIA and DXA was better for obese children than for underweight or normal-weight children.

Objective: To investigate the effect of maternal passive smoking during pregnancy and girls’ overweight /obesity on the age at menarche(AAM), and to provide a reference for improving healthy development of children and adolescents. Methods: Based on the school entrance physical examination in 2016, a cross-section study was conducted by convenient sampling method, in a total of 2 722 students of 7th grade, from 26 middle schools in urban areas of Guangzhou. Multivariate logistic regression model was used to investigate the relationship between maternal passive smoking during pregnancy and girls’ overweight /obesity and AAM. A four-way decomposition method was used to explore the mediated effect of girls’ overweight/obesity on the relationship between maternal passive smoking during pregnancy and AAM. Results: The proportion of girls who had menstruate was 90.82%(2 472/2 722). The median AAM was 12.00 years old, with an early menarche rate of 34.91%(863/2 472). Compared with girls whose mother hadn’t passive smoking during pregnancy, the risk of early AAM in girls with mother passive smoking during pregnancy≤3 days/week increased by 32%(OR=1.32, 95%CI=1.06-1.65), the risk in girls with maternal passive smoking during pregnancy>3 days/week increased by 58%(OR=1.58, 95%CI=1.21-2.07). Multivariate Logistic regression analysis showed that, overweight or obesity girls had a 77% higher risk of early AAM than non-overweight/obesity girls(OR=1.77, 95%CI=1.36-2.31). The four-way decomposition analysis showed 79.60% of early AAM risk could be accounted by maternal passive smoking during pregnancy(P<0.01). Conclusion Girls’ overweight/obesity and maternal passive smoking during pregnancy were associated with early menarche. The effect on daughters’ age at menarche is mainly in a direct effect manner of maternal passive smoking during pregnancy.

OBJECTIVETo investigate the predictive value of hepatic venous pressure gradient (HVPG) for early bleeding after esophageal variceal ligation (EVL) by analyzing the differences in HVPG in patients with and without post-EVL bleeding.

METHODSThe medical records of patients who had been diagnosed with cirrhosis and esophageal varices and who had pre-EVL HVPG measurement data were surveyed. The study population included 105 patients from October 2010 to March 2014. Data of HVPG value, previous treatment history, endoscopic manifestation, and whether bleeding and serious complications occurred within 2 weeks after the ligation procedure were investigated as independent risk factors.

STATISTICAL METHODSincluded the chi-square test and Wilcoxon test, logistic regression modeling and receiver operating characteristic (ROC) analysis using the SPSS software version 16.

RESULTSOnly HVPG value was identified as an independent risk factor of early bleeding after EVL.According to the ROC analysis, the area under the curve (AUC) of HVPG for early bleeding after EVL was 0.866; when HVPG was more than or equal to 16 mmHg, AUC was 0.838. The sensitivity was 90.9% and the specificity was 76.4%.

CONCLUSIONHVPG is an independent factor of early bleeding after EVL and when HVPG cut-off value of more than or equal to 16 mmHg is used the predictive ability has certain accuracy and high sensitivity and specificity.

Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Humans ; Hypertension, Portal ; Ligation ; Liver Cirrhosis ; Portal Pressure ; ROC Curve ; Risk Factors

Objective To investigate the efficacy of percutaneous transhepatic variceal embolization (PTVE) with Cyanoacrylate (TH glue) in treating large gastric fundal variceal bleeding.Methods PTVE was performed on 24 patients with TH glue injected into the main stem of left gastric vein and its fundic branches.The degree of varices in gastric fundus,rebleeding rate and survival rate after the procedure were compared with those before.Results Varices in gastric fundus were all embolized successfully with TH glue.The diameter of varices was reduced to below 5mm or disappeared in 20 patients (83.3％),and reduced to 5-10mm in the other 4 ( 16.7％ ) During the follow-up period of 3-36 months(mean 16.6 months),the rebleeding rate and mortality were 12.5 ％ ( 3/24 ),and 12.5 ％ (3/24),respectively.One patient died of liver cancer,and two others died of chronic liver failure.Conclusion PTVE with TH glue is of ideal therapeutic effect to block the feeding veins of large gastric fundal varices.

BACKGROUNDTo evaluate the efficacy and toxicity of concomitant chemoradiotherapy in patients with brain metastases from non-small cell lung cancer (NSCLC).

METHODSThirty patients suffering from NSCLC with brain metastasis were prospectively included in this study. Twenty-four patients had neurological symptoms and an ECOG performance index between 0 and 3. Treatment consisted of concomitant whole brain radiotherapy (WBRT) with a dose of 30 Gy in 15 fractions, followed by a local boosted dose of 20 Gy in 10 fractions for those that the number of the remained lesions were less than 3, or by WBRT with a total dose of 50 Gy for those that the number of the remained lesions were more than 3. Concomitant chemotherapy of FVP regimen with floxuridine 600 mg/(m²*d), teniposide 60 mg/(m²*d), cisplatin 20 mg/(m²*d) on d1 to d5,repeating every 3 or 4 weeks. The response was evaluated by brain CT or MRI after WBRT and 2 cycles of chemotherapy being completed.

RESULTSAll the patients completed WBRT and concomitant chemotherapy including 68 cycles (2 to 4 cycles for each patient). The follow-up rate was 93.3% with a median survival duration of 11.3 months. Total response rate was 46.7%, with CR for 2 and PR for 12. Specific evaluation of brain response demonstrated CR for 8 patients, and PR for 10 patients (the objective brain response rate, 60.0% ). The objective primary disease response rate was 18% for 22 cases of previously untreated primary NSCLC. Other specific evaluation of metastases included 1 PR patient in 6 patients with lung metastases, 3 CR patients and 4 PR patients in 17 patients with lymph node metastases, 1 PR patient with liver metastases, and 1 PR patient with eye metastasis. Twenty four patients with neurological symptoms benefited improvements to different extent. The main adverse effects were myelotoxicity, nausea/vomiting, constipation and alopecia. Grade III and IV toxicities were observed as following: leucopenia (19.1%), anemia (10.3%), thrombocytopenia (7.4%), nausea/vomiting (4.4%), diarrhea (2.9%), alopecia (5.9%), glutamio oxaloacetic transaminase (GOT) and glutamio pyruvic transaminase (GPT) elevation (1.5%). Dehydration therapy was needed at 2 weeks after WBRT in all patients.

CONCLUSIONSConcomitant WBRT plus FUDR+VM-26+DDP chemotherapy is tolerable in NSCLC patients with brain metastases and the short term response is comparable to the results of others.