Biliary atresia（BA）is the most common cause of liver disease in children leading to liver transplantation.Kasai operation is the main treatment method.Earlier diagnosis and younger age of operation can greatly improve the prognosis.Although the diagnosis and treatment of BA have been gradually improved in recent years，some patients still need liver transplantation or even die due to cirrhosis.There is still a lack of non-invasive prognostic evaluation methods.This article reviews the value of serum matrix metalloproteinase-7（MMP-7）level in the early diagnosis of biliary atresia，and discusses the relationship between MMP-7 level and the prognosis of children with biliary atresia，and how MMP-7 participates in the mechanism of the occurrence and development of biliary atresia，so as to provide reference for clinical diagnosis and treatment.

Objective:To explore the association between hair trace element and all-cause death in the elderly in Hainan Province.Methods:The subjects of the study were elderly people from China Hainan Centenarian Cohort Study, a total of 163 elderly were included. The association between hair trace element level and all-cause death was analyzed by using Cox proportional risk regression model.Results:After fully adjusting the covariates, the multiple Cox proportional hazards regression analyses showed that selenium (Se), manganese (Mn), strontium (Sr) concentrations in hair were significantly associated with all-cause mortality, the hazard ratio ( HR) were 0.72 (95% CI: 0.54-0.98, P=0.035), 1.50 (95% CI: 1.07-2.11, P=0.020) and 0.54 (95% CI: 0.37-0.79, P=0.001), respectively. Subgroup and cross analysis showed that hair copper (Cu) were significant association with death in the people with anemia, the HR were 1.81 (95% CI: 1.13-2.88, P=0.013). And, hair Mn interacted with anemia, the HR was 0.46 (95% CI: 0.22-0.94, P=0.033). Conclusions:Se, Mn and Sr concentrations in hair were associated with the elevated risk for all-cause death in the elderly in Hainan. Se, Mn and Sr concentrations in hair can be used as a reference index for the prediction of the death risk of long-lived elderly in community, suggesting that the daily diet of elderly people are rich and diverse, in order to maintain normal and balanced trace element content in the body.

Objective:To observe the clinical and imaging characteristics of radiation optic neuropathy (RION).Methods:A retrospective clinical study. A total of 43 patients (69 eyes) who were diagnosed with RION at the Chinese PLA General Hospital from 2010 to 2021 were included in this study. There were 23 males (36 eyes) and 20 females (33 eyes). The age of patients at the time of radiation therapy was 49.54±13.14 years. The main dose of radiotherapy for lesions was 59.83±14.12 Gy. Sixteen patients were treated with combined chemotherapeutic agents. The clinical details of best corrected visual acuity (BCVA) and color photography of the fundus were collected. Forty-six eyes underwent optical coherence tomography (OCT), visual field were examined in 30 eyes, magnetic resonance imaging (MRI) were performed in 40 eyes. The BCVA examination was performed using Snellen visual acuity chart, which was converted to minimum resolution angle logarithm (logMAR) visual acuity during recording. Hyperbaric oxygen therapy (HBOT) was performed in 10 patients (13 eyes), 9 patients (12 eyes) were treated with intravenous methylprednisolone (IVMP), 12 patients (23 eyes) were treated with HBOT combined with IVMP and control group of 12 patients (21 eyes) were only treated with basal treatment. And grouped accordingly. To observe the changes in onset, recovery, and final BCVA of the affected eye as well as thickness changes of the retinal nerve fiber layer (RNFL) of the optic disc and inner limiting membrane-retinal pigment epithelium (ILM-RPE) layer of the macular area, and final outcome of BCVA with different treatment modalities in affected eyes. The RNFL and ILM-RPE layer thicknesses were compared between patients with different disease duration as well as between treatment regimens using independent samples t-test. Results:Of the 43 cases, vision loss was monocular in 17 patients (39.53%, 17/43) and binocular in 26 patients (60.47%, 26/43). The latency from radiotherapy to onset of visual loss was 36.33±30.48 months. The duration of RION ranged from 1 week to 10 years, in which the disease duration of 37 eyes ≤2 months. Subacute visual acuity loss was present in 41 eyes. logMAR BCVA<1.0, 1.0-0.3, >0.3 were 45, 15, and 9 eyes, respectively. Optic disc pallor and optic disc edema were found in 10 (27.03%, 10/37), 3 (8.11%, 3/37) eyes, respectively, within 2 months. The superior RNFL [95% confidence interval ( CI) 2.08-66.56, P=0.038] and the outer circle of the inner limiting membrane to retinal pigment epithelium (ILM-RPE) (95% CI 4.37-45.39, P=0.021) layer thinned significantly during the first month. The center of the ILM-RPE layer thickened (95% CI-32.95--4.20, P=0.015) significantly during the first two months. The inner circle temporal quadrant of the ILM-RPE layer thickened (95% CI -42.22--3.83, P=0.022) significantly from the third to sixth month, and the RNFL except for the temporal quadrants and the average RNFL, inner circle superior quadrant and outer circle of the ILM-RPE layer thinned significantly after 6 months ( P<0.05). Among the 40 eyes that underwent MRI examination, 33 eyes (82.50%, 33/40) were affected by T1 enhancement of optic nerve, including 23 eyes (69.70%, 23/33) in intracranial segment; 12 eyes with thickening and long T2 signal (36.36%, 12/33). After treatment, BCVA was restored in 17 eyes (24.6%, 17/69) and final BCVA improved in 9 eyes (13.0%, 9/69). There was no significant difference between HBOT, IVMP and HBOT combined with IVMP therapy in improving BCVA recovery or final BCVA compared with the control group, respectively ( t=-1.04, 0.61, 1.31,-1.47, -0.42, 0.46; P>0.05). Conclusions:The structural damage of the RNFL and ILM-RPE layer occurred during the first month, the RNFL showed progressive thinning during the follow-up period, while the ILM-RPE layer showed thinning-thickening-thinning. MRI shows T1 enhancement of the optic chiasma and segments of the optic nerve, and the enhanced segments are usually accompanied by thickening and long T2. HBOT and IVMP have no obvious effect on RION.

Objective:To investigate the application of critical flicker fusion frequency (CFF) in non-arteritic anterior ischemic optic neuropathy (NAION).Methods:A cross-sectional study. From January 2021 to September 2021, a total of 58 NAION patients (105 eyes) (NAION group) and 33 cases (63 eyes) in the healthy control (HC) group were included from Department of Ophthalmology of First Medical Center, PLA General Hospital. Patients underwent best-corrected visual acuity (BCVA), optical coherence tomography (OCT), visual field, CFF and flash visual evoked potential (F-VEP) examinations. BCVA examination was performed using a Snellen decimal visual acuity chart and was converted to logarithm of the minimum angle of resolution visual acuity. In the affected eyes group, there were 56 cases (72 eyes), 31 cases (43 eyes) male and 25 cases (29 eyes) female, with an average age of 49.28±11.42 years old. And the affected eyes were divided into 4 groups: <1, 1-<3, 3-<6 and >6 months according to the time interval from onset to CFF examination, which were 20(27.8%), 26 (36.1%), 17 (23.6%) and 9 (12.5%) eyes, respectively. According to the BCVA ≥0.5, 0.1-0.5, <0.1 in CFF examination, the affected eyes were divided into a mild, moderate, and severe degree, 33 (45.8%), 32(44.4%) and 7 (9.8%) eyes, respectively. Sixty-three eyes of 33 cases were in the HC group. There were 17 cases(31 eyes) males and 16 cases (32 eyes) females, with an average age of 35.18±10.96 years. Hand-held CFF detector type 2 (Japan, NEITZ company) was used for the CFF examination. The thickness of peripheral retinal nerve fiber layer (pRNFL), macular inner limiting membrane retinal pigment epithelium (mILM-RPE), F-VEP peak time and peak value and mean visual field defect (MD) values were recorded within 1 week of CFF examination. The CFF value of the above subgroups was analyzed in order using one-way ANOVA. Pearson correlation analysis was used for the correlation between CFF and F-VEP peak time, peak value, BCVA and MD. The correlations between BCVA, visual field, F-VEP, and CFF were analyzed.Results:The trichromatic values of red, green and yellow in NAION affected eyes were 22.56±10.30, 24.10±11.51, 24.81±11.41 Hz, respectively, which was significantly reduced compared with the HC group ( t=-10.53,-11.11,-11.36; P<0.05). There was no significant difference in CFF-red, green, and yellow values at different time points after the onset of the disease ( F=2.075, 1.893, 2.073; P>0.05). Compared CFF-red, green, and yellow values in NAION-affected eyes with different degrees, the difference was statistically significant ( F=31.579, 27.332, 32.055; P<0.05). The results of correlation analysis showed that the peak time of F-VEP ( r=-0.362, -0.379,-0.357; P<0.05), BCVA ( r=-0.705,-0.695,-0.714; P<0.05), and which was negatively correlated with CFF three color. MD and CFF were positively correlated ( r=0.486, 0.435, 0.450; P<0.05). Conclusion:The CFF value of the affected eye is decreased significantly in NAION-affected eyes, and CFF is more sensitive than F-VEP in reflecting visual impairment, and has a good correlation with visual function and latency of F-VEP.

Objective:To evaluate the occurrence of nocturnal hypotension (NHP) in nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A evidence-based medicine study. Chinese and English as search terms for NAION and NHP was used to search literature in PubMed of National Library of Medicine, Embase, Web of science, Cochrane Library, Clinical Trials, Wanfang, and China National Knowledge Infrastructure and China Biology Medicine disc. Incomplete or irrelevant literature and review literature were excluded. The literature was meta-analyzed using Review Manager 5.4 and STATA 15.0. The 95% confidence interval ( CI) were selected as the estimated value of effect size, the occurrence of NHP in NAION was calculated, and sensitivity analysis and publication bias analysis were also performed to assess the robustness of pooled outcomes. Results:According to the search strategy, 159 articles were initially retrieved, and 8 articles were finally included for meta-analysis, three prospective studies and five retrospective studies. The occurrence of NHP in NAION was 43% (95% CI, 0.36-0.50). Sensitivity analyses confirmed that the evidence was robust. Subgroup analyses showed that the occurrence of NHP in NAION nearly the same in White patients (47%, 95% CI 0.39-0.55) and Chinese patients (41%, 95% CI 0.32-0.51). The occurrence of NHP in NAION was higher in using night mean artery pressure (45%, 95% CI 0.31-0.60) as the diagnostic criteria than using night systolic blood pressure & night diastolic blood pressure (40%, 95% CI 0.32-0.50). Conclusions:The occurrence of NHP in NAION was 43%; the occurrence was similar in patients of different ethnicities. The diagnosis rate could be improved by using nMAP < 70 mm Hg (1 mm Hg=0.133 kPa) as a diagnostic criterion for NHP. Careful intervention should be taken for the blood pressure of patients with NAION and NHP.

Neuromyelitis optica spectrum disorder (NMOSD) is a kind of demyelinating disease of central nervous system which mainly affect optic nerve and spinal cord. Because of its serious blindness and disability, how to effectively prevent relapse has become the focus of ophthalmologists. With the deep understanding of the pathogenesis and the progress of scientific and technological means, more and more monoclonal antibodies(mAb) continue to enter clinical trials. B cell surface antigen CD20 blocker, rituximab, has become a first-line drug for the treatment of NMOSD. CD19 blocker, inebilizumab, can reduce the recurrence and disability of NMOSD patients. The addition of interleukin 6 receptor blocker, satralizumab, and complement C5 inhibitor, eculizumab, reduce the recurrence. Some mAbs such as natalizumab and alemtuzumab may not be effective for the treatment of NMOSD. The expansion of mAb treatment indications and the launch of new drugs still require more clinical trials which are large-scale and international cooperation. At the same time, its potential adverse events and cost issues cannot be ignored.

Objective: To evaluate the health status of Hainan centenarians and compare the gender disparity, and to determine whether the'male-female health-survival paradox’is present among them. Methods: A cross-sectional study was conducted on the health status and gender disparity of individuals aged 100 and over in Hainan province from June 2014 to December 2016.Data of sociodemographics, lifestyles as well as health-related parameters were collected.The multi-dimensional health assessment of centenarians was conducted based on the recognition of standard on Chinese healthy elderly in 2013. Results: A total of 940 centenarians(men 18.6%, women 81.4%)were included.The prevalences of hypertension, diabetes and dyslipidemia were 66.1%, 9.8%, and 21.2%, respectively, while no significant gender difference was found.Male centenarians were more independent in activity of daily living than did female centenarians(41.1% vs.25.9%, P<0.001). The prevalences of dementia(7.7% vs.4.0%)and depression(33.6% vs.18.9%)were more dominant in females than in males.Multivariate logistic regression showed that the proportions of functional disability, depression and sleep disorders were higher in female centenarians than in male centenarians(P<0.05)after adjusting for general demographic characteristics, lifestyle and other health indicators. Conclusions Although the female proportion dominates the centenarian population, female general health states are worse than male centenarians.More attentions on physical and mental health should be paid to the female centenarians.

Objective To investigate the anesthetic efficacy of topical dyclonine hydrochloride mucilage for preputial encircling in children. Methods Sixty children under preputial encircling, 13 patients with redundant prepuce, 47 patients with phimosis, aged 4-12 years, weighing 14-38 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups with 30 cases each: dyclonine group (group D) and control group (group C). Children with redundant prepuce in group D were smeared evenly 1％ dyclonine hydrochloride mucilage on the anterior 2/3 foreskins, glans and coronary sulcus by anesthesiologists who were assisted by the their parents 30 min before entering the operating room. Children with phimosis in group D were smeared evenly 1％ dyclonine hydrochloride mucilage on the anterior 2/3 foreskins, and then the tube was inserted near the coronary sulcus with the 18# straight indwelling needle. The syringe was injected into the 1％ dyclonine hydrochloride mucilage, and the glans and the coronary sulcus were squeezed repeatedly several times by anesthesiologists who were assisted by the their parents 30 min before entering the operating room. The dosage of dyclonine hydrochloride mucilage for each child was 0.2-0.3 ml/kg. Children in group C were smeared evenly isodose normal saline at the same time. All the children were treated with ketamine and propofol anesthesia after entering. The occurrence of intraoperative body reaction were observed and recorded, HR and MAP were recorded before anaesthesia induction (T0), at the beginning of surgery (T1), at the time of the coronary sulcus was exposed (T2), at the time of ligating (T3), at the time of the excess foreskin was cut (T4), the dosage of ketamine and propofol were recorded, and the occurrence of postoperative recovery time and emergence agitation during recovery period were observed. Results Body dynamic reaction rate in group D was significantly lower than that in group C (P ＜ 0.05), HR and MAP was significantly lower than that in group C at T3-T4 (P ＜ 0.05), the dosage of ketamine and propofol was significantly smaller than that in group C (P ＜ 0.05), the recovery time was significantly shorter than that in group C (P ＜ 0.05), the incidence of emergence agitation was significantly decreased compared with group C (P ＜ 0.05). Conclusion Topical dyclonine hydrochloride mucilage can effectively decrease body movement, lessen cyclic fluctuation, economize general anesthetics, shorten recovery time, reduce emergence agitation in children undergoing preputial encircling.

Objective To explore the effects of sleep situation on circadian rhythm of blood pressure in elderly hypertension patients.Methods Two hundred and thirty patients (aged ≥ 60 years) with hypertension treated in the Department of Geriatric Cardiology of PLA General Hospital were enrolled in the study from October 2016 to December 2016.After admission,the clinical and laboratory tests data and examinations of the patients were collected and analyzed.The patients' sleep was investigated by Pittsburgh sleep quality index (PSQI).The ambulatory blood pressure rhythm was divided into three groups:reverse-dipper group (n=110),non-dipper group (n=86),and dipper group (n=34).The clinical data and sleep situation of different blood pressure rhythm groups were compared,and the effects of sleep situation on different blood pressure rhythm were analyzed.Results The total PSQI score with six domains[P＜0.01,except hypnotic drug (P＞0.05)]was significantly lower in dipper group than in reverse-and non-dipper group.The sleep situation was significantly better in dipper group than in reverse-and non-dipper group (P＜0.05).Multiple linear regression analysis showed a significant negative correlation between total PSQI score and nocturnal blood pressure drop after adjusting for risk factors of hypertension (β =-0.651,P ＜0.01).Furthermore,after further adjusting for the seven domains of the PSQI score,the negative correlation remained between the sleep time score and the nocturnal blood pressure drop (β=-1.926,P =0.031).The elderly hypertension patients with shorter sleep duration had a lower rate of nocturnal blood pressure decline,and were prone to present the reverse-dipper and non-dipper blood pressure rhythm.Conclusions The elderly hypertension patients with poor sleep quality,especially with short sleep duration,are prone to present the reverse-dipper and non-dipper blood pressure rhythm.Short sleep duration can be used as a predictor for abnormal blood pressure rhythm.

Objective To study the anesthetic effect of oral dyclonine hydrochloride mucilage combined with laryngopharyngeal spray of lidocaine in infant esophagus dilatation.Methods Eighty infants with anastomotic stenosis after surgical correction of esophageal atresia under esophagus dila-tation assisted with gastroscope,51 males and 29 females,age 6 months to 3 years,weighing 5-12 kg,ASA physical status Ⅰ or Ⅱ,were randomly divided into four groups with 20 cases each:general anesthesia group (group A),general anesthesia combined with dyclonine surface anesthesia group (group B),general anesthesia combined with lidocaine surface anesthesia (group C),general anesthesia combined with dyclonine and lidocaine surface anesthesia group (group D).Infants in group B and group D were given 1 % dyclonine hydrochloride mucilage 0.2-0.3 ml/kg by their parents who were guided by the anesthesiologist at 10-15 min before entering the operating room,followed by slow intravenous injection of penehyclidine hydrochloride 0.01-0.02 mg/kg, propofol 2-2.5 mg/kg, remifentanil 1 μg/kg.After the induction,the children of group C and group D were exposed to 2% lidocaine 0.1 5-0.2 ml/kg through laryngoscope under laryngoscope to spray the laryngeal mucosa surface.All the children were converted to oxygen supply (6 L/min)asing double nasal high flow af-ter the mask was added to the stable breathing.Anesthesia was maintained by propofol 6 mg·kg-1·h-1,remifentanil 0.1 μg·kg-1·h-1infusion.In the case of somatic or choking during the operation,propofol and (or)remifentanil were inj ected into the pump to deepen the anesthesia. The occurrence of intraoperative oxygen saturation (SpO2<94%),cough and body reaction were ob-served and recorded,and the occurrence of postoperative recovery time and emergence agitation during recovery period were observed.Results The patients with oxygen saturation in group D de-creased,the incidence of cough was significantly lower than that of groups A and B (P<0.05 ), without significant difference in group C, body dynamic reaction rate was significantly lower compared with the other three groups (P<0.05),the recovery time was significantly shorter com-pared with the other three groups (P<0.05),the incidence of emergence agitation significantly de-creased (P<0.05).Conclusion Oral dyclonine hydrochloride mucilage combined with laryngopha-ryngeal spray of lidocaine can effectively decrease hypoxemia,cough,body movement,shorten recov-ery time,reduce emergence agitation in infants undergoing the esophageal dilatation.