Objective To investigate the habits of eye rubbing and sleeping posture of patients with keratoconus(KC)and analyze the correlation of the onset and severity of KC with eye rubbing and sleeping posture.Methods In this retrospective case-control study,KC patients who received diagnosis and treatment in the Eye Hospital of Shandong First Medical University from January 2018 to June 2022 were collected as the KC group,and myopia patients with matching ages and sexes who visited our hospital from February to June 2022 were recruited as the control group.All patients were inves-tigated by questionnaire and the details of eye rubbing,sleeping posture and related habits were recorded.According to the severity of the disease(corneal curvature),KC patients were divided into different stages,and the eye rubbing and sleep-ing posture of KC patients in different stages were compared.Results In this study,406 KC patients and 394 myopia pa-tients were included.It was found that 67.98％of KC patients and 24.87％of myopia patients rubbed their eyes,with a sig-nificant difference(P＜0.001);45.32％of KC patients and 24.87％of myopia patients were accustomed to sleeping on their side or stomach,with a significant difference(P＜0.001).The multivariate binary logistic regression analysis indica-ted that the following variables showed significant differences:patients with eyes at the later stages(steeper eyes)were more likely to rub eyes[odds ratio(OR)=3.547,95％CI:2.02-6.24,P＜0.001],sleep on side or stomach(OR=10.725,95％CI:5.77-19.94,P＜0.001),and turn head to the steeper eye when sleeping(OR=12.171,95％CI:7.23-20.49,P＜0.001).The statistical analysis demonstrated that the proportion of KC patients at the IV stage who were habitu-ated to rub their steeper eyes and turn their heads to the steeper eyes when sleeping was significantly higher than that of pa-tients at stages Ⅰ to Ⅲ(all P＜0.001).Conclusion Eye rubbing and sleeping on the side or stomach are risk factors for the onset of KC and are related to the severity of the disease.

A 20-year-old female patient took compound Zaoren capsules (containing processed ziziphi Spinosae Semen and L-tatrahydropal matine, 1 capsule at bedtime, 12 capsules in total) by herself intermittently due to insomnia. Fifteen days later, she developed fatigue and dark yellow urine. Laboratory tests showed total bilirubin (TBil) 62 μmol/L, direct bilirubin (DBil) 49 μmol/L, alanine aminotransferase (ALT) 1 658 U/L, aspartate aminotransferase (AST) 1 525 U/L, γ-glutamic trans-ferase (GGT) 160 U/L, alkaline phosphatase (ALP) 149 U/L, and total bile acid (TBA) 90.2 μmol/L. She received liver-protective treatments. After 30 days, the symptoms of fatigue and dark yellow urine were relieved, and laboratory tests showed TBil 24 μmol/L, DBil 13 μmol/L, ALT 54 U/L, AST 68 U/L, GGT 170 U/L, and ALP 90 U/L. Nine months later, the patient took compound Zaoren capsules (1 capsule/4 d, 3 capsules in total) again due to insomnia. Fourteen days later, the patient developed yellow sclera and dark yellow urine, and laboratory tests showed TBil 44 μmol/L, DBil 29 μmol/L, ALT 2 041 U/L, AST 1 152 U/L, GGT 110 U/L, ALP 155 U/L, and TBA 28.0 μmol/L. The liver-protective treatments were given again, and the symptoms of yellow sclera and urine were relieved 18 days later. Laboratory tests showed ALT 199 U/L, AST 78 U/L, and GGT 55 U/L. The liver injury is considered to be caused by tetrahydropalmatine in compound Zaoren capsules.

A 20-year-old female patient took compound Zaoren capsules (containing processed ziziphi Spinosae Semen and L-tatrahydropal matine, 1 capsule at bedtime, 12 capsules in total) by herself intermittently due to insomnia. Fifteen days later, she developed fatigue and dark yellow urine. Laboratory tests showed total bilirubin (TBil) 62 μmol/L, direct bilirubin (DBil) 49 μmol/L, alanine aminotransferase (ALT) 1 658 U/L, aspartate aminotransferase (AST) 1 525 U/L, γ-glutamic trans-ferase (GGT) 160 U/L, alkaline phosphatase (ALP) 149 U/L, and total bile acid (TBA) 90.2 μmol/L. She received liver-protective treatments. After 30 days, the symptoms of fatigue and dark yellow urine were relieved, and laboratory tests showed TBil 24 μmol/L, DBil 13 μmol/L, ALT 54 U/L, AST 68 U/L, GGT 170 U/L, and ALP 90 U/L. Nine months later, the patient took compound Zaoren capsules (1 capsule/4 d, 3 capsules in total) again due to insomnia. Fourteen days later, the patient developed yellow sclera and dark yellow urine, and laboratory tests showed TBil 44 μmol/L, DBil 29 μmol/L, ALT 2 041 U/L, AST 1 152 U/L, GGT 110 U/L, ALP 155 U/L, and TBA 28.0 μmol/L. The liver-protective treatments were given again, and the symptoms of yellow sclera and urine were relieved 18 days later. Laboratory tests showed ALT 199 U/L, AST 78 U/L, and GGT 55 U/L. The liver injury is considered to be caused by tetrahydropalmatine in compound Zaoren capsules.

Objective To evaluate the therapeutic effect of thymosin alpha -1 with glucocorticoid in treat-ment of HBV -related hepatic failure.Methods 130 cases were randomly divided into two groups,they were all giv-en antiviral therapy,protect liver,anti -inflammatory,yellow suit the back support,etc.comprehensive treatment;and patients in treatment group were given thymosin alpha -1 with methyl -prednisone intravenously at the early stage of treating process,and then observed the clinic situation and cure rate of those sufferers,The biochemiccal indicator, PTA and blood serum HBV DNA capacity ending with the period of 4 weeks were tested.Results In both groups,the TBil,TC in serum had apparently improved compared with the baseline after the medication,the difference was signifi-cant (t =3.12,P <0.05 and t =3.05,P <0.05).The time of gastrointestinal symptoms improvement and bilirubin subsided time in treatment group were significantly shorter than those of the control group(t =3.34,P <0.01 and t =4.52,P <0.01 ).During the treatment,there was no significant adverse reaction,and there were no differences between two groups in Alt,PTA,HBV DNA,infection,gastrointestinal bleeding,hepatic encephalopathy and hepatore-nal syndrome.The effective rate of treatment group was 75.2%,which was higher than 50.3% of the control group (χ2 =11.02,P <0.01).Conclusion Patients with HBV -related hepatic failure of short -term application of thy-mosin alpha -1 with glucocorticoid treatment,can quickly improve symptoms,greatly improve the efficiency of survival rate,shortem hospitalization period,reduce side effects and enhance security.