AIM: To investigate the effect of accommodation on peripheral refraction in patients with myopia.METHODS: Cross-sectional study. A total of 105 patients(105 eyes)with myopia were consecutively recruited in this study. According to the degree of myopia, patients were divided into high myopia(SE≤-6.00 D), moderate myopia(-6.00 D0.017).CONCLUSION: The accommodation can affect the peripheral defocus in myopic patients, and the effect on moderate and low myopia is greater than that of high myopia.

Objective To investigate the effect of orthokeratology(OK)lens decentration on peripheral retinal defo-cus in myopic eyes.Methods Totally 154 patients(234 eyes)continuously wearing OK lenses for one month or more were recruited in this study.According to the location of defocus rings in corneal topography,these eyes were divided into the centration group(118 eyes)and the decentration group(116 eyes).Peripheral retinal defocus data of each patient was collected by multispectral refraction topography,including total refraction difference value(TRDV),refraction difference value at 15°(RDV-15),refraction difference value at 30°(RDV-30),refraction difference value at 45°(RDV-45),superior refraction difference value(RDV-S),inferior refraction difference value(RDV-I),temporal refraction difference value(RDV-T)and nasal refraction difference value(RDV-N).An independent sample t-test was used to compare the differ-ences in these parameters between the two groups,and multivariate correlation analysis(generalized estimating equation,GEE)was conducted to analyze the relationship between clinical parameters and the amount of peripheral retinal defocus within the group.Results The RDV-N of patients in the decentration group was significantly lower than that in the cen-tration group(t=2.668,P=0.008),and there were no significant differences in other parameters(all P＞0.05).GEE showed that age was the determinant of RDV-S,and they were positively correlated;steep K was the determinant of RDV-I,and they were negatively correlated;gender was the determinant of RDV-T,and female OK lens wearers showed less RDV-T;the determinants of RDV-N include the alignment of OK lens,eye distribution and age,among which,RDV-N was positively corrected with age,and RDV-N of the left eyes was significantly superior to that of the right eyes.Conclusion Subclinical decentration of the OK lens may result in better RDV-N of myopia patients.The peripheral retinal defocus is influenced by factors such as age,gender,steep K,amount of decentration and eye distribution of OK lens wearers.

Severe and critically ill patients with coronavirus disease 2019 (COVID-19) were usually with underlying diseases, which led to the problems of complicated drug use, potential drug-drug interactions and medication errors in special patients. Based on ( 6), and -19: , we summarized the experience in the use of antiviral drugs, corticosteroids, vascular active drugs, antibacterial, probiotics, nutrition support schemes in severe and critically ill COVID-19 patients. It is also suggested to focus on medication management for evaluation of drug efficacy and duration of treatment, prevention and treatment of adverse drug reactions, identification of potential drug-drug interactions, individualized medication monitoring based on biosafety protection, and medication administration for special patients.
Adrenal Cortex Hormones ; adverse effects ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Antiviral Agents ; adverse effects ; therapeutic use ; Betacoronavirus ; isolation & purification ; Coronavirus Infections ; drug therapy ; Critical Illness ; Drug Therapy ; Humans ; Nutritional Support ; Pandemics ; Pneumonia, Viral ; drug therapy ; Probiotics ; administration & dosage

Objective: To evaluate the preliminary efficacy and safety of the 5-fluorouracil/leucovorin, irinotecan, and oxaliplatin (FOLF-OXIRI) and capecitabine, irinotecan, and oxaliplatin (CAPIRINOX) regimens as first-line therapy for unresectable advanced colorectal cancer. Methods: Between January 2013 and November 2018, 73 patients with metastatic colorectal cancer (mCRC) were analyzed. All patients received first-line chemotherapy. Of them, 45 patients were administered FOLFOXIRI, and the remaining 28 patients were ad-ministered CAPIRINOX. The clinical outcomes and safety profiles were evaluated according to the objective response rate (ORR), con-version resection rate, and adverse effects. Results: The ORR, median progression-free survival (mPFS), and R0 resection rate in the FOLFOXIRI group were not statistically different from those in the CAPIRINOX group (60% vs. 57.1%, 7.7 months vs. 9.6 months, 24.4% vs . 17.9% , respectively; P>0.05). No treatment-related deaths occurred. The major adverse events were leukopenia, neutropenia, fa-tigue, nausea, vomiting, diarrhea, alopecia, aspartate aminotransferase/alanine aminotransferase elevation, and neurotoxicity. The to-tal rate of grade 3/4 adverse events in the FOLFOXIRI group was 33.3% (15/45), while the total rate of grade 3/4 adverse events in the CAPIRINOX group was 46.4% (13/28). Toxicities between the two groups were not statistically significant (P=0.263). Conclusions: Both the FOLFOXIRI and CAPIRINOX regimens are effective as first-line treatment for metastatic colorectal cancer. The triple-agent chemo-therapy was associated with good efficacy and tolerable toxicity.

Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease.As a dengue non-endemic country,China has experienced several dengue outbreaks in recent years.However,dengue patients in China displayed distinct clinical characteristics compared to patients in endemic countries.To standardize the diagnosis and treatment of dengue fever,the experts of the Society of Infectious Diseases,Society of Tropical Medicine and Parasitology of Chinese Medical Association,and the Society of Emergency Medicine,China Association of Chinese Medicine have reached this guideline based on guidelines for diagnosis,treatment,prevention and control of dengue (World Health Organization,2009);guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China,2014,Edition 2),health industry standard of the People's Republic of China "diagnosis for dengue fever (WS216-2018)" and systemic reports on dengue.The guideline includes 8 aspects:introduction,terminology,epidemiology and prevention,etiology and pathogenesis,clinical features,diagnosis,treatment and problems to be solved.

Objective: To explore the significance of next-generation sequencing for the screening of high-risk hereditary gastrointesti-nal cancer patients and the value of high-risk factors in screening. Methods: Twenty-five hereditary high-risk gastrointestinal cancer pa-tients from March 2016 to April 2016 in Peking University Cancer Hospital were enrolled. They received detection of 42 hereditary can-cer syndrome related genes by next-generation sequencing. Results: Out of 25 patients enrolled, 24% (6/25) patients had pathological germline mutations. The expression of mismatch repair protein was absent in 50% (3/6) patients. There were 83% (5/6) patients with family history of malignant tumors and were diagnosed when younger than 50 years. Six patients had hereditary cancer syndrome re-lated gene mutation, 1 patient had MYH gene missense mutation, 1 patient had APC gene deletion mutation, 4 patients had heredi-tary colorectal cancer related gene mutation, including MLH1, MLH3, and TGFBR2 germline missense mutations as well as MSH6 non-sense mutation. Conclusions: Out of 25 patients with high-risk factors of hereditary gastrointestinal cancer, 6 (24%) had pathological germline mutations. Given the high frequency and wide spectrum of mutations, the application of next-generation sequencing for screening of hereditary high-risk gastrointestinal cancer patients has the clinical value for improving the positive rate of diagnosis.

Objective:Influence of clinicopathological characteristics and different therapy patterns on the overall survival of patients with gastric cancer with bone metastasis was investigated. Methods:A total of 146 gastric cancer patients with bone metastasis were enrolled from December 1996 to December 2014. Data of clinicopathological characteristics, treatment methods, and overall survival were collected. Univariate and multivariate analyses were performed using log-rank tests and Cox's proportional hazard model, respec-tively. Results:A total of 51 (34.9%) patients had synchronous metastasis, while 95 (65.1%) had metachronous metastasis. Moreover, 35 (24.0%) patients only had bone metastasis, while 111 (76.0%) patients were complicated with other organ metastases, such as liver (30.0%), peritoneal (24.0%), lung (15.1%), and bone marrow (7.5%). After diagnosis of bone metastasis, bisphosphonates, bone radio-therapy and bone surgery were applied in 99 (67.8%), 34 (23.3%), and 5 (3.4%) patients, respectively. Additionally, 96 (65.6%) patients received palliative chemotherapy. The median overall survival was 5.8 months (95%CI:4.284-7.316). Multivariate analysis revealed that KPS<80 (P=0.030), bone marrow metastasis (P<0.001), elevated serum CA199 (P<0.001), and without palliative chemotherapy (P<0.001) were independent poor prognostic factors. Conclusion:The outcome of gastric cancer with bone metastasis is very poor, espe-cially in patients with bone marrow metastasis, worse KPS, and elevated CA199. Palliative chemotherapy may be beneficial for the sur-vival of these patients.

Objective To explore the effect of uremic clearance granule combined with losartan potassium on the microinflammation status and peritoneal function in patients underwent peritoneal dialysis (PD).Methods A total of 60 patients with end-stage renal disease (ESRD) who were admitted in our hospital from August 2014 to February 2016 for continuous ambulatory PD (CAPD) were included in the study and randomized into observation group and control group.The patients in the two groups were performed with CAPD.The patients in the control group were orally administrated with losartan potassium tablets.On this basis,the patients in the observation group were given uremic clearance granules.After 1-year treatment,the efficacy was evaluated.PET was performed in the beginning and at the end and 24 h urine volume and 24 h ultrafiltration volume were recorded.Meanwhile,RRF was determined.Hs-CRP,IL-6,TNF-α,TGF-β1,VEGF,and FN were detected.Results RRF,24h urine volume and 24h ultrafiltration volume in 1 year after treatment in the two groups were significantly reduced compared with treatment before (P ＜ 0.05),while PET was significantly elevated (P ＜ 0.05).The reduced degree of RRF,24 h urine volume and 24 h ultrafiltration volume in 1 year after treatment in the observation group was significantly less than that in the control group (P ＜ 0.0 5),and the elevated degree of PET was significantly less than that in the control group (P ＜ 0.05).Hs-CRP,IL-6,and TNF-α in 1 year after treatment in the two groups was significantly reduced compared with treatment before (P ＜ 0.05).The reduced degree of hsCRP,IL-6,and TNF-α in 1 year after treatment in the observation group was significantly greater than that in the control group (P ＜0.05).TGF-β1,VEGF,and FN in 1 year after treatment in the two groups were significantly elevated compared with treatment before (P ＜ 0.05).The elevated degree of TGF-β1,VEGF,and FN in 1 year after treatment in the observation group was significantly less than that in the control group.Conclusion Uremic clearance granule in combined with losartan potassium can effectively improve the microinflammation status,inhibit PF,protect the peritoneal function,and delay the reduction of RRF.

Objective To explore the effect of uremic clearance granule combined with losartan potassium on the microinflammation status and peritoneal function in patients underwent peritoneal dialysis (PD).Methods A total of 60 patients with end-stage renal disease (ESRD) who were admitted in our hospital from August 2014 to February 2016 for continuous ambulatory PD (CAPD) were included in the study and randomized into observation group and control group.The patients in the two groups were performed with CAPD.The patients in the control group were orally administrated with losartan potassium tablets.On this basis,the patients in the observation group were given uremic clearance granules.After 1-year treatment,the efficacy was evaluated.PET was performed in the beginning and at the end and 24 h urine volume and 24 h ultrafiltration volume were recorded.Meanwhile,RRF was determined.Hs-CRP,IL-6,TNF-α,TGF-β1,VEGF,and FN were detected.Results RRF,24h urine volume and 24h ultrafiltration volume in 1 year after treatment in the two groups were significantly reduced compared with treatment before (P ＜ 0.05),while PET was significantly elevated (P ＜ 0.05).The reduced degree of RRF,24 h urine volume and 24 h ultrafiltration volume in 1 year after treatment in the observation group was significantly less than that in the control group (P ＜ 0.0 5),and the elevated degree of PET was significantly less than that in the control group (P ＜ 0.05).Hs-CRP,IL-6,and TNF-α in 1 year after treatment in the two groups was significantly reduced compared with treatment before (P ＜ 0.05).The reduced degree of hsCRP,IL-6,and TNF-α in 1 year after treatment in the observation group was significantly greater than that in the control group (P ＜0.05).TGF-β1,VEGF,and FN in 1 year after treatment in the two groups were significantly elevated compared with treatment before (P ＜ 0.05).The elevated degree of TGF-β1,VEGF,and FN in 1 year after treatment in the observation group was significantly less than that in the control group.Conclusion Uremic clearance granule in combined with losartan potassium can effectively improve the microinflammation status,inhibit PF,protect the peritoneal function,and delay the reduction of RRF.

Objective To observe dosage of insulin and analysis of glucose metabolism characteristics in the patients during the process of diabetic nephropathy (DN).Methods A total of 84 cases of diabetic nephropathy admitted into the Department of Nephrology of the hospital for treatment from January 2013 to December 2015 were chosen for the study.In accordance with the chronic kidney disease ( CKD) stages standards, as specified in the National Kidney Foundation′s Kidney Disease Treatment Guidelines, the DN process in the same patient was divided into 5 different stages:stage 1 ( CKD phase Ⅰand Ⅱ) , stage 2 ( CKD phase Ⅲ and Ⅳ) , stage 3 ( CKD phaseⅤand prior to dialysis therapy) , stage 4 ( CKD phase Ⅴand dialysis therapy for 1 to 3 months) , stage 5 ( CKD phase Ⅴand dialysis therapy for over 6 months) .Data pertaining to body mass, body mass index( BMI) , dosage of insulin and hemo-globin A1c(HbA1c), glomerular filtration rate (GFR), hemoglobin(Hb), fasting plasma glucose(FBG), postprandial blood glucose ( PBG) after 2 hours and albumin( ALB) were collected during the 5 stages, then were compared and analyzed statistically.Results During the first 3 stages, there were significant differences in the levels of GFR, Hb and ALB, as well as in dosage of insulin in the 84 patients(P<0.01), and the levels of GFR, Hb and ALB were all significantly higher than those of the second and third stages(P<0.01).The dosage of insulin during the first stage was (0.62 ±0.20) U/kg, which was significantly higher than those of the second and third stages〔(0.44 ±0.17) U/kg, (0.42 ±0.20) U/kg〕.However, no statistical significance could be seen in the dosage of in-sulin in the patients during the second and third stages(P>0.05).There were significant differences in the levels of GFR, Hb, ALB, and the dosage of insulin during the third, fourth and fifth stages for the 84 patients(P<0.01 or P<0.05).And the dosage of insulin during the third stage was significantly higher than those of the fourth and fifth stages (P<0.01).However, no statistical significance could be noted in the dosage of insulin during the fourth and fifth stages (P>0.05).The rates of hypoglycemia during the fourth and fifth stages were respectively 10 cases and 11 cases, which were all significantly higher than that of the third stage (2 cases) (P<0.05).Conclusion When the disease status of the DN patients developed from CKD Ⅰ~Ⅱphase to CKD Ⅲ~Ⅳ, the dosage of in-sulin should be reduced, and when it developed from CKD Ⅲ~Ⅳto CKD Ⅴ before the implementation of dialysis, the dosage could still remain at relatively stable level.However, when dialysis therapy was implemented for 1 to 3 months, the dosage of insulin should further be reduced.From then onwards, the dosage of insulin could remain basically unchanged.At the same time, for those patients with DN, measures should be taken for the prevention of hypoglycemia during dialysis therapy.