Objective: To explore the current status of hyperopic reserve and its related factors among non-myopia preschool and primary school students aged 5 to 12 years in Guangdong Province, so as to provide a basis for formulating intervention strategies for the pre myopia stage of children. Methods: From October to December 2023, by using stratified cluster random sampling method, a survey on hyperopic reserve among preschool children and primary school students in Guangdong were conducted. And a total of 10 567 children from the senior class of kindergarten to the sixth grade of primary school who completed autorefraction measurements with and without cycloplegia and the questionnaire survey were included in the study. The prevalence characteristics of low hyperopic reserve among non-myopia children were analyzed, and multivariable Logistic regression was used to analyze the related factors. Results: The prevalence rate of low hyperopic reserve among 8 790 non-myopia children was 62.4%. The average spherical equivalent (SE) for children aged 5 to 12 years was 0.88 (0.25, 1.25)D, decreasing from 1.13 ( 0.75 , 1.50)D in senior kindergarten to -1.00 (-2.50, 0.38)D in sixth grade, with the difference was statistically significant ( H=2 475.3, P <0.01). Multivariable Logistic regression analysis, after adjusting for confounders including gender, urban and rural, and grade, revealed that parental myopia was a risk factor for low hyperopic reserve in the preschool stage (one parent with myopia: OR=1.62, 95%CI =1.35-1.93; both parents with myopia: OR=2.05, 95%CI = 1.66 -2.55); in the lower primary school stage, parental myopia (one parent with myopia: OR=1.46, 95%CI =1.27-1.68; both parents with myopia: OR=1.58, 95%CI =1.33-1.89), frequently or always reading or using electronic screens while lying down or on one s stomach ( OR=1.43, 95%CI =1.13-1.81), and never or occasionally maintaining a viewing distance of over 3 meters when watching TV/playing video games ( OR=1.34, 95%CI =1.04-1.72) were risk factors; in the higher primary school stage, failing to take a break every hour during near work ( OR=1.79, 95%CI =1.16-2.75) was a risk factor (all P <0.05). Conclusions The emmetropization of children aged 5-12 years in Guangdong Province is accelerated, and non-myopia children generally exhibit insufficient hyperopic reserve. The contributing factors for insufficient hyperopia reserve in non-myopia children vary across different educational stages, necessitating targeted precision interventions.

Malignant pleural effusion(MPE)is a common complication in patients with advanced malignant tumors,which not only significantly reduces their quality of life but also shortens their survival duration.Despite the widespread use of traditional treatment methods such as thoracentesis and pleurodesis,their efficacy is limited accompanied by high recurrence rates.Therefore,exploring novel therapeutic strategies becomes particularly urgent.In recent years,immunotherapy has attracted extensive attention for its potential in cancer treatment.This article systematically reviews the roles of CD4+T cell subsets,including regulatory T cells(Treg),T helper cell(Th)17,Th9,and Th22 cells,within the immunosuppressive microenvironment of MPE.These cell subsets are involved in the formation of the immunosuppressive state of MPE through various mechanisms and play key roles in the occurrence and development of the disease.In addition,the article discusses in detail the role of immune checkpoint molecules,such as programmed death protein 1(PD-1),PD-1 ligand(PD-L1),and cytotoxic T-lymphocyte-associated protein 4(CTLA-4),in the immune evasion of MPE.The abnormal expressions of these molecules provide opportunity for tumor cells to evade immune system surveillance.At the same time,this article also summarizes the application prospects of novel immunotherapy strategies,such as adoptive cell therapy(ACT)and chimeric antigen receptor T cell(CAR-T)therapy,in the treatment of MPE.These innovative therapies offer possibilities for improving the prognosis of MPE patients through activating and enhancing the anti-tumor immune response.

Objective To investigate the effect of lactic acid(Lac)on chemotherapy resistance in colon cancer through activation of the SOX9-TRAF2 signaling pathway in tumor-associated macrophages(TAMs).Methods A chemotherapy-resistant colon cancer cell line(SW480-R)was established using a gradient exposure method.M0 macrophages were treated with 0,5,10,or 20 mmol/L Lac.Levels of trans-forming growth factorβ(TGF-β)and arginase 1(Arg1)in the supernatant were measured by ELISA.M0 macrophages were then treated with 0 or 20 mmol/L Lac,either alone or in combination with SOX9knockdown.SW480-R cells were treated with conditioned medium(CM)derived from the macrophage treatments(0 mmol/L Lac-CM,20 mmol/L Lac-CM,or 20 mmol/L Lac+si-SOX9-CM).Cell viability was assessed using the MTT assay,and cell migration was evaluated using Transwell assays.SOX9 protein expression was measured via Western blotting.TRAF2 ubiquitination and protein expression were evaluated after SOX9knockdown in SW480-R cells.The effect of Lac on chemotherapy resistance in vivo was assessed using a 5-FU and Lac co-intervention model.Results Lac treatment significantly increased TGF-βand Arg1 levels in macrophage supernatants(both P<0.05).Compared to the 0 mmol/L Lac-CM group,the 20 mmol/L Lac-CM group showed significantly increased SW480-R cell viability,migration,and SOX9 protein expression(all P<0.05).SOX9knockdown partially reversed the Lac-in-duced changes in SW480-R cell behavior.Furthermore,SOX9knockdown increased TRAF2 ubiquitination and decreased TRAF2 protein expression(both P<0.05).In vivo,5-FU effectively inhibited tumor growth,whereas Lac administration attenuated the therapeutic efficacy of 5-FU.Conclusion Lac promotes chemotherapy resistance in colon cancer by activating the SOX9-TRAF2 signaling pathway in TAMs.

Objective·To explore the metabolic profiling and metabolic reprogramming patterns of lung cancer cells with acquired resistance to sotorasib,a specific inhibitor to KRAS.Methods·The H2122 and H358 lung cancer cell models with acquired resistance to sotorasib(H2122-SR and H358-SR cells)were established and validated by CCK-8 assay.Ultra-performance liquid chromatography tandem quadrupole time-of-flight mass spectrometry(UPLC-QTOF/MS)was employed to acquire the metabolic profiling of the resistant lung cancer cells and their homologous parental cells.Untargeted metabolomics studies and metabolic characterizations were conducted with multi-dimensional methods,including principal component analysis(PCA)and partial least squares-discriminant analysis(PLS-DA),to identify differential metabolites associated with acquired resistance to sotorasib.Then these differential metabolites were subjected to pathway enrichment analysis.Heatmap analysis was used to compare the changes in metabolites in major differential metabolic pathways between the resistant and parental cells.Results·The cell models of H2122 and H358 with acquired resistance were successfully constructed,with half-maximal inhibitory concentrations(IC50)of sotorasib being 50 times higher than those of the parental cells.Besides,the metabolic profiling was significantly different between the resistant and parental cells.A total of 48 differential metabolites were identified between H2122-SR and H2122 cells.The top 10 differential metabolites,ranked by VIP values,were uridine,xanthylic acid,indole-3-carboxylic acid,nicotinic acid,xanthosine,xanthine,N-methylnicotinamide,hypoxanthine,trigonelline,and galactonic acid.Between H358-SR and H358 cells,a total of 79 differential metabolites were identified.The top 10 differential metabolites,ranked by VIP values,were glutathione,xanthosine,2-ketoglutaric acid,carboxyethyl lysine,thymidine,purine,riboflavin,3-indoleacrylic acid,indole-3-pyruvic acid,and dihydrouracil.The differential metabolites in the two lung cancer cell lines mainly participated in purine metabolism and glycolysis/gluconeogenesis,and purine metabolism was the most significantly altered metabolic pathway.Heatmap analysis showed that many metabolites in the purine metabolism were elevated in the sotorasib-resistant cells.Conclusion·The lung cancer cells with acquired resistance to sotorasib show enhanced purine metabolism.

Objective:To investigate the multimorbidity of myopia and obesity, as well as myopia and malnutrition, among children and adolescents aged 7-18 in Guangdong Province and analyze their epidemiological characteristics and related factors.Methods:A stratified random cluster sampling method was used to select 274 939 children and adolescents aged 7-18 from 21 cities in Guangdong Province in 2023. Physical examination information such as height, weight, distance vision, and diopter, as well as questionnaire survey information on dietary behavior, physical activity, screen behavior, sleep time, etc., were collected to analyze the current status and trends of multimorbidity between myopia and obesity, myopia and malnutrition. The multivariate logistic regression model was used to analyze the related factors of multimorbidity.Results:The multimorbidity rates of myopia and obesity, myopia and malnutrition in children and adolescents aged 7-18 in Guangdong Province in 2023 were 4.43% and 6.40%, respectively. The multimorbidity rates for males were 5.44% and 6.88%, respectively, which were higher than those for females, about 3.31% and 5.88% (both P<0.001). The multimorbidity rates of urban students were 5.03% and 6.73%, respectively, which were higher than those of county students at 4.03% and 6.18% (both P<0.001). The multimorbidity rates of myopia and obesity, myopia and malnutrition increased with the increase of academic stage (all P<0.001). The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, fluctuated with age, with the first decrease occurring at the age of 12. The multivariate logistic regression analysis showed that compared to children and adolescents aged 7-18 who had daily after-school tutoring <2 hours, daily screen time <2 hours, did not consume sugary drinks every day, sleep time that could meet health requirements daily, and exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who had daily after-school tutoring ≥2 hours ( OR=1.18, 95% CI: 1.11-1.26), daily screen time ≥2 hours ( OR=1.09, 95% CI: 1.02-1.16), consumed sugary drinks every day ( OR=1.20, 95% CI: 1.11-1.30), daily sleep time that could not meet the health requirements ( OR=1.16, 95% CI: 1.09-1.23), and no exercise per week ( OR=1.09, 95% CI: 1.01-1.18) had a higher risk of multimorbidity of myopia and obesity. Compared to children and adolescents who exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who exercised <3 days per week ( OR=1.20, 95% CI: 1.17-1.34) had a higher risk of multimorbidity of myopia and malnutrition. Conclusion:The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, in children and adolescents aged 7-18 in Guangdong Province are relatively low and fluctuate with age. Physical activity, screen time, consumption of sugary drinks, and sleep time may be associated with these multimorbidities.

Objective:To analyze the management benefits of information-based management mode for medical imaging equipment,and promote rational management for equipment and improve management benefits of equipment.Methods:According to the existing information management system and electronic medical record system at Tangdu hospital,Air Force Medical University,a management platform for medical imaging equipment under information-based management mode for medical imaging equipment was constructed to manage medical imaging equipment.A total of 9 imaging equipment included magnetic resonance(MR)equipment,computed tomography(CT)equipment and X-ray equipment that were in clinical use during 2022 and 2023 were selected,and the conventional management mode was adopted to manage equipment during January and December 2022,and the information-based management mode was adopted to manage them during January and December 2023.The comprehensive management benefits of the two modes for medical imaging equipment were compared.A self-designed questionnaire was used to survey satisfaction levels of 80 patients who underwent diagnosis and treatment by using these equipment.Results:The annual examination amount,annual revenue,annual operating cost,and annual net profit of MRI,CT,and X-ray equipment of adopting information-based management mode were all higher than those of adopting conventional management mode,and the investment payback period was shorter than that of adopting conventional management mode,and the cost-effectiveness evaluation was superior to conventional management mode.The average utilization rate of equipment,rate of maintenance and upkeep,and rate of controlling risk of adopting information-based management mode were respectively(95.36±6.02)%,(92.36±4.36)%and(94.36±4.15)%,which were significantly higher than those of adopting conventional management mode(t=14.317,11.62,12.508,P<0.05).Patients'satisfactions for MRI equipment,CT equipment and X-ray equipment that adopted information-based management mode were significantly higher than these that adopted conventional management mode,and the differences were significant(x2=5.741,6.260,5.331,P<0.05).Conclusion:The information-based management mode for medical imaging equipment can real-timely obtain the situations of usage and monitoring for medical imaging equipment,and enhance cost-effectiveness and management effectiveness at the maximum extent,and enhance users'satisfaction in using medical equipment.

Objective To explore the characteristics of coagulation and immune function and their clinical significance in children with severe adenovirus pneumonia(SAP).Methods A total of 122 children with SAP and 120 children with non-severe adenovirus pneumonia(NSAP)were enrolled and assigned to severe group and non-severe group.The severe group was further subdivided into good prognosis subgroup(n=105)and poor prognosis subgroup(n=17)according to prognosis.Addition-ally,120 healthy children undergoing physical examination during the same period were included as control group.Coagulation function indicators,including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and thrombin time(TT)were measured.Levels of immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM)were determined using the nephelometric immunoassay.Multivariate Cox regression analysis was conducted to explore the influencing factors of poor prognosis.Results Compared with the control group,children in both the non-severe and severe groups exhibited increased levels of white blood cells(WBC),neutrophils(N),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),procalci-tonin(PCT),FIB,and IgG,as well as decreased levels of B lymphocytes,natural killer(NK)cells,PT,APTT,IgA,and IgM(P＜0.05).Compared with the non-severe group,children in the severe group showed increased levels of WBC,N,CRP,ESR,IL-6,PCT,FIB,and IgG,as well as decreased levels of B lymphocytes,NK cells,PT,APTT,IgA,and IgM(P＜0.05).Compared with the good prognosis subgroup,the poor prognosis subgroup exhibited increased levels of CRP,IL-6,PCT,and IgG,as well as decreased levels of APTT,IgM,and IgA(P＜0.05).The results of multivariate Cox regression analysis showed that PCT,APTT,and IgM were influencing factors of poor prognosis in children with SAP(P＜0.05).Conclusion Children with SAP have decreased levels of PT,APTT,IgA,and IgM,as well as increased levels of FIB and IgG.Coagulation and im-mune function indicators are correlated with the prognosis of SAP.

Objective:To analyze the management benefits of information-based management mode for medical imaging equipment,and promote rational management for equipment and improve management benefits of equipment.Methods:According to the existing information management system and electronic medical record system at Tangdu hospital,Air Force Medical University,a management platform for medical imaging equipment under information-based management mode for medical imaging equipment was constructed to manage medical imaging equipment.A total of 9 imaging equipment included magnetic resonance(MR)equipment,computed tomography(CT)equipment and X-ray equipment that were in clinical use during 2022 and 2023 were selected,and the conventional management mode was adopted to manage equipment during January and December 2022,and the information-based management mode was adopted to manage them during January and December 2023.The comprehensive management benefits of the two modes for medical imaging equipment were compared.A self-designed questionnaire was used to survey satisfaction levels of 80 patients who underwent diagnosis and treatment by using these equipment.Results:The annual examination amount,annual revenue,annual operating cost,and annual net profit of MRI,CT,and X-ray equipment of adopting information-based management mode were all higher than those of adopting conventional management mode,and the investment payback period was shorter than that of adopting conventional management mode,and the cost-effectiveness evaluation was superior to conventional management mode.The average utilization rate of equipment,rate of maintenance and upkeep,and rate of controlling risk of adopting information-based management mode were respectively(95.36±6.02)%,(92.36±4.36)%and(94.36±4.15)%,which were significantly higher than those of adopting conventional management mode(t=14.317,11.62,12.508,P<0.05).Patients'satisfactions for MRI equipment,CT equipment and X-ray equipment that adopted information-based management mode were significantly higher than these that adopted conventional management mode,and the differences were significant(x2=5.741,6.260,5.331,P<0.05).Conclusion:The information-based management mode for medical imaging equipment can real-timely obtain the situations of usage and monitoring for medical imaging equipment,and enhance cost-effectiveness and management effectiveness at the maximum extent,and enhance users'satisfaction in using medical equipment.

Objective To investigate the effect of lactic acid(Lac)on chemotherapy resistance in colon cancer through activation of the SOX9-TRAF2 signaling pathway in tumor-associated macrophages(TAMs).Methods A chemotherapy-resistant colon cancer cell line(SW480-R)was established using a gradient exposure method.M0 macrophages were treated with 0,5,10,or 20 mmol/L Lac.Levels of trans-forming growth factorβ(TGF-β)and arginase 1(Arg1)in the supernatant were measured by ELISA.M0 macrophages were then treated with 0 or 20 mmol/L Lac,either alone or in combination with SOX9knockdown.SW480-R cells were treated with conditioned medium(CM)derived from the macrophage treatments(0 mmol/L Lac-CM,20 mmol/L Lac-CM,or 20 mmol/L Lac+si-SOX9-CM).Cell viability was assessed using the MTT assay,and cell migration was evaluated using Transwell assays.SOX9 protein expression was measured via Western blotting.TRAF2 ubiquitination and protein expression were evaluated after SOX9knockdown in SW480-R cells.The effect of Lac on chemotherapy resistance in vivo was assessed using a 5-FU and Lac co-intervention model.Results Lac treatment significantly increased TGF-βand Arg1 levels in macrophage supernatants(both P<0.05).Compared to the 0 mmol/L Lac-CM group,the 20 mmol/L Lac-CM group showed significantly increased SW480-R cell viability,migration,and SOX9 protein expression(all P<0.05).SOX9knockdown partially reversed the Lac-in-duced changes in SW480-R cell behavior.Furthermore,SOX9knockdown increased TRAF2 ubiquitination and decreased TRAF2 protein expression(both P<0.05).In vivo,5-FU effectively inhibited tumor growth,whereas Lac administration attenuated the therapeutic efficacy of 5-FU.Conclusion Lac promotes chemotherapy resistance in colon cancer by activating the SOX9-TRAF2 signaling pathway in TAMs.

Objective:To investigate the multimorbidity of myopia and obesity, as well as myopia and malnutrition, among children and adolescents aged 7-18 in Guangdong Province and analyze their epidemiological characteristics and related factors.Methods:A stratified random cluster sampling method was used to select 274 939 children and adolescents aged 7-18 from 21 cities in Guangdong Province in 2023. Physical examination information such as height, weight, distance vision, and diopter, as well as questionnaire survey information on dietary behavior, physical activity, screen behavior, sleep time, etc., were collected to analyze the current status and trends of multimorbidity between myopia and obesity, myopia and malnutrition. The multivariate logistic regression model was used to analyze the related factors of multimorbidity.Results:The multimorbidity rates of myopia and obesity, myopia and malnutrition in children and adolescents aged 7-18 in Guangdong Province in 2023 were 4.43% and 6.40%, respectively. The multimorbidity rates for males were 5.44% and 6.88%, respectively, which were higher than those for females, about 3.31% and 5.88% (both P<0.001). The multimorbidity rates of urban students were 5.03% and 6.73%, respectively, which were higher than those of county students at 4.03% and 6.18% (both P<0.001). The multimorbidity rates of myopia and obesity, myopia and malnutrition increased with the increase of academic stage (all P<0.001). The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, fluctuated with age, with the first decrease occurring at the age of 12. The multivariate logistic regression analysis showed that compared to children and adolescents aged 7-18 who had daily after-school tutoring <2 hours, daily screen time <2 hours, did not consume sugary drinks every day, sleep time that could meet health requirements daily, and exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who had daily after-school tutoring ≥2 hours ( OR=1.18, 95% CI: 1.11-1.26), daily screen time ≥2 hours ( OR=1.09, 95% CI: 1.02-1.16), consumed sugary drinks every day ( OR=1.20, 95% CI: 1.11-1.30), daily sleep time that could not meet the health requirements ( OR=1.16, 95% CI: 1.09-1.23), and no exercise per week ( OR=1.09, 95% CI: 1.01-1.18) had a higher risk of multimorbidity of myopia and obesity. Compared to children and adolescents who exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who exercised <3 days per week ( OR=1.20, 95% CI: 1.17-1.34) had a higher risk of multimorbidity of myopia and malnutrition. Conclusion:The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, in children and adolescents aged 7-18 in Guangdong Province are relatively low and fluctuate with age. Physical activity, screen time, consumption of sugary drinks, and sleep time may be associated with these multimorbidities.