AIM: To evaluate the reliability of a digital multimedia system for measuring near-distance horizontal heterophoria.METHODS: This cross-sectional diagnostic study enrolled patients with refractive errors who visited Shantou Aier Eye Hospital from May 2023 to August 2025, presenting with symptoms of visual fatigue, undergoing myopia management, or receiving routine ophthalmic examinations, and who completed heterophoria testing during this period. All patients wearing full refractive correction underwent near-distance(0.4 m)horizontal heterophoria measurement in a random order using the digital multimedia system, the Von Graefe method, and the Maddox rod method. Two consecutive measurements were performed for each method. The intraclass correlation coefficient(ICC)was used to analyze the measurement repeatability of each method, and Bland-Altman analysis and Spearman correlation analysis were employed to evaluate the consistency between the digital multimedia system and the two traditional methods.RESULTS: A total of 60 patients(120 eyes)were included, comprising 27 males and 33 females, with a mean age of 21.03±7.24 y. Repeatability analysis showed that the ICC for the digital multimedia system was 0.960(95%CI: 0.934-0.976), for the Von Graefe method was 0.979(95%CI: 0.964-0.987), and for the Maddox rod method was 0.956(95%CI: 0.926-0.973), all indicating excellent repeatability. Bland-Altman analysis revealed a mean difference of 0.367△ [95% limits of agreement(LoA): -2.97△ to 3.70△] between the Von Graefe method and the digital system, and a mean difference of 0.067△(95% LoA: -3.05△ to 3.19△)between the Maddox rod method and the digital system. Both differences were within the clinically acceptable range(difference <4△). Spearman correlation analysis showed positive correlations between the digital system and the Von Graefe method(rs=0.867)and between the digital system and the Maddox rod method(rs=0.777, all P<0.001).CONCLUSION: The digital multimedia system demonstrates high repeatability and good consistency with the traditional Von Graefe and Maddox rod methods for measuring near-distance horizontal heterophoria. It shows promise as a new and effective tool for clinical near-distance horizontal heterophoria measurement.

Objective: To explore differences in the factors influencing parents and teachers assessments of preschool children s mental health using the Strengths and Difficulties Questionnaire (SDQ), so as to provide reference for promoting children s mental health. Methods: A retrospective analysis was conducted on the SDQ survey data of 14 763 middle and senior kindergarten children in Nanshan District, Shenzhen, from March to June 2023. Chi square χ 2 tests were used to analyze differences in mental health assessments between parents and teachers. Multivariate Logistic regression was employed to examine the factors influencing parental assessments, and Kappa coefficients were used to evaluate the consistency between parent and teacher evaluations. Results: The positive rate of mental health problems reported by parents (7.2%) was significantly higher than that reported by teachers (6.2%) ( χ 2=254.27, P <0.01). Gender differences revealed that parents reported a lower positive rate for boys (7.9%) compared to teachers (8.5%), whereas for girls, the parental positive rate (6.4%) was higher than that reported by teachers (3.8%) ( χ 2=163.59, 81.26, all P <0.01). Age related differences showed that parental positive rates for 4, 5, and 6 year olds (8.5%, 7.4%, 5.8%) were consistently higher than teachers assessments (6.3%, 6.7%, 5.4%) ( χ 2=41.23, 157.53, 63.67, all P <0.05). Univariate analysis of parental assessments indicated higher positive rates among boys (7.9%), 4 year olds (8.5%), mothers aged 20-35 ( 6.6 %), mothers with high school education or below (9.8%), fathers aged 23-40 (6.4%), fathers with high school education or below (10.3%), and children exposed to secondhand smoke (7.9%) ( χ 2=23.56-235.24, all P <0.01). Multivariate Logistic regression identified lower parental education levels and exposure to secondhand smoke as significant risk factors for abnormal SDQ assessments by parents ( χ 2=2.05, 1.62, 3.15, all P <0.05). The Kappa coefficients for parent-teacher agreement across SDQ subscales and total difficulties ranged from 0.04 to 0.12 (all P <0.01). Conclusions Parental education level and exposure to secondhand smoke are significant factors influencing preschool children s mental health. Differences exist between parental and teacher assessments of children s mental health, and incorporating teacher evaluations can provide a more comprehensive understanding of preschoolers psychological well being.

Objective:To evaluate the long-term impact of three different outdoor activity intervention strategies on the prevalence of myopia among school-aged children in China.Methods:Cross-sectional data from the Refractive Error Study in Children (RESC) on the baseline prevalence of myopia and 10-year longitudinal data from the Guangzhou Twin Eye Study (GTES) on the baseline incidence of myopia were utilized.The effect size of outdoor activity intervention was derived from longitudinal data of the Guangzhou Outdoor Activity Longitudinal Study (GOALS). Three intervention strategies were proposed: intervention for children in grades 1 to 6 (Strategy A), intervention for children in grades 1 to 3 (Strategy B), and intervention for children from the last year of kindergarten to grade 3 (Strategy C). Outdoor activity interventions across all strategies included an extra 40 minutes of daily outdoor activity time.Simulated analyses assumed that the prevalence of myopia would decrease with declining incidence and increasing school grade, and the degree of myopia among highly myopic children would decrease with delayed myopia onset.This study was approved by the Ethics Committee of Zhongshan Ophthalmic Center (No.2006-5).Results:With prolonged intervention time, the overall prevalence of myopia in children showed a significant declining trend.After 5 years of implementation, Strategy A resulted in a decrease in myopia prevalence from 34.67% to 25.71%, which decreased to 24.89% after 10 years, with an average annual reduction of 0.98%.Strategies B and C had similar long-term effects, with myopia prevalence after 10 years being 26.00% and 26.20% respectively, with an average annual reductions of 0.87% and 0.85%.Strategy A yielded the greatest reduction in myopia severity, with a decrease of -5.94 D after 5 years and -5.88 D after 10 years in the initial 15-year-old highly myopic individuals.Strategy B followed with -6.08 D and -6.02 D after 5 and 10 years, respectively.Conclusions:Implementing intensified outdoor activity intervention among children in grades 1 to 6 may be the recommended strategy to reduce the overall prevalence of myopia in regions with high rates of myopia among school-aged children.

Objective:To investigate the effects of docetaxel for postoperative chemotherapy of advanced gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 311 patients with advanced gastric cancer who were admitted to Lanzhou University Second Hospital from January 2013 to December 2018 were collected. There were 224 males and 87 females, aged from 26 to 82 years, with a median age of 58 years. Of 311 patients, 204 cases undergoing chemotherapy with the FOLFOX regimen (oxaliplatin, calcium folinate, 5-fluorouracil) were allocated into the FOLFOX group, and 107 cases undergoing chemotherapy with the FLOT regimen (docetaxel, oxaliplatin, calcium folinate, 5-fluorouracil) were allocated into the FLOT group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups of patients after matching; (2) follow-up; (3) analysis of survival factors; (4) subgroup analysis; (5) adverse reactions. Follow-up was performed using a combination of outpatient examination, hospitalization review and telephone interview to detect situations of patients chemotherapy, postoperative survival, tumor recurrence and metastasis up to February 2019. The propensity score matching was realized using the nearest neighbor method with 1: 1 ratio and caliper setting as 0.02. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability method. Rank data was analyzed using non parametric Rank sum test. The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method. The survival analysis was done using the Log-rank test. Univariate analysis and multivariate analysis were conducted using the COX regression model. Subgroup analysis was done using interaction test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups of patients after matching: 198 of 311 patients had successful matching, including 99 in each group. Cases with tumor differentiated as poorly differentiation or well differentiation, cases with CA19-9 <27 U/mL or ≥27 U/mL, cases with CA125 <35 U/mL or ≥35 U/mL before propensity score matching were 109, 95, 156, 48, 186, 18 in the FOLFOX group, and 42, 65, 93, 14, 104, 3 in the FLOT group, respectively, showing significant differences in the above indicators between the two groups ( χ2=5.649, 4.798, 4.039, P<0.05). After propensity score matching, the above indicators were 44, 55, 85, 14, 96, 3 in the FOLFOX group, and 42, 57, 85, 14, 96, 3 in the FLOT group, respectively, showing no significant difference in the above indicators between the two groups ( χ2=0.082, 0.000, 0.000, P>0.05). (2) Follow-up: 198 patients of the two groups after matching were followed up for 2 to 69 months, with a median follow-up time of 38 months. During the follow-up, 92 cases survived without tumor, 2 cases underwent tumor recurrence or metastasis, and 104 cases died including 103 with tumor related death and 1 case with non-tumor related death. The courses of chemotherapy were 5.6±0.7 and 5.4±0.8 for the FOLFOX group and FLOT group, respectively, showing no significant difference between the two groups ( t=1.651, P>0.05). The 1, 3, and 5-year cumulative survival rates of patients were 72.2%, 31.5%, 27.7% and 83.2%, 42.8%, 38.2% for the FOLFOX group and FLOT group, respectively. The median overall survival time were 21 months and 34 months for the FOLFOX group and FLOT group, respectively, showing significant difference between the two groups ( χ2=4.473, P<0.05). (3) Analysis of survival factors: results of univariate analysis showed that cases undergoing chemotherapy with the FLOT regimen, cases with tumor as diffuse type of Lauren classification, cases with tumor as mixed type of Lauren classification, cases with tumor differentiated as well differentiation, cases with tumor diameter≥5 cm, cases with CA19-9≥27 U/mL, cases with carcinoembryonic antigen (CEA)≥3.4 μg/L, cases with tumor as T4 stage of T staging, cases with tumor as N2 stage of N staging, cases with tumor as N3 stage of N staging, cases undergoing distal gastrectomy and cases undergoing total gastrectomy were related factors influencing postoperative survival of patients ( hazard ratio=0.659, 1.617, 1.798, 0.672, 1.726, 1.655, 1.942, 2.036, 2.536, 4.085, 1.810, 2.310, 95% confidence interval: 0.444-0.978, 1.024-2.556, 1.105-2.926, 0.457-0.990, 1.159-2.569, 1.006-2.723, 1.295-2.912, 1.190-3.484, 1.409-4.564, 2.491-6.697, 1.020-3.211, 1.261-4.233, P<0.05). Results of multivariate analysis showed that cases undergoing chemotherapy with the FLOT regimen, cases with CEA≥3.4 μg/L, cases with tumor as N2 stage of N staging and cases with tumor as N3 stage of N staging were independent risk factors influencing postoperative survival of patients ( hazard ratio=0.622, 1.732, 2.217, 4.039, 95% confidence interval: 0.418-0.926, 1.124-2.670, 1.200-4.097, 2.448-6.662, P<0.05). (4) Subgroup analysis: results of subgroup analysis showed that of the different subgroups using gender, age, tumor Lauren classification, tumor differentiation degree, tumor location, tumor diameter, tumor markers, tumor T staging, tumor N staging and surgical procedures as subgrouping index, the efficacy difference between the FLOT group and the FOLFOX group was the same (interaction P>0.05). (5) Adverse reactions: the incidence of grade Ⅲ-Ⅳ adverse reactions of leukopenia, anemia, thrombocytopenia, nausea, vomiting and liver and kidney dysfunction were 11.1%(11/99), 2.0%(2/99), 3.0%(3/99), 12.1%(12/99), 4.0%(4/99), 1.0%(1/99) and 34.3%(34/99), 1.0%(1/99), 9.1%(9/99), 24.2%(24/99), 4.0%(4/99), 0 in the FOLFOX group and the FLOT group, respectively. There were significant differences of the incidence of leukopenia and nausea between the two groups ( χ2=15.213, 4.889, P<0.05). There was no significant difference of the incidence of thrombocytopenia between the two groups ( χ2=3.194, P>0.05) and there was no significant difference of the incidence of anemia, vomiting and liver and kidney dysfunction between the two groups ( P>0.05). There was no patient in the two group withdrawal from chemotherapy as no tolerance to toxic reactions. All patients were treated with glucocorticoids, proton pump inhibitors and serotonin receptor antagonists during chemotherapy. Patients undergoing leukopenia were treated with granulocyte stimulating factor. Conclusions:Compared with FOLFOX regimen, FLOT regimen which adds docetaxel significantly prolongs the postoperative median overall survival time of patients with advanced gastric cancer. However, FLOT regimen increases the incidence of grade Ⅲ-Ⅳ adverse reactions of leukopenia and nausea.

Gastric neuroendocrine tumors are rarely seen in the gastric tumors, because there are few case reports and the clinical diagnosis rate is low. There is no consensus treatment method in the world. However, with the benefit of esophagogastrodenoscopy and widespread use of proton pump inhibitors, the diagnostic rate of gastric neuroendocrine tumors is on the increase, which gives us an updated understanding for the pathogenesis and pathophysiology of the disease. By studying its pathogenesis, scholars have found that hypergastrinemia caused by various causes is closely related to its occurrence. Gastric neuroendocrine tumors are classified into different types or pathological grades depending on the state of progression of the disease and the unique clinical manifestations. Clinically used diagnostic methods include gastroscopy, medical imageology, nuclear medicine, gastrin, CgA, etc. There are also differences in treatments depending on the clinical classification. If the disease progresses rapidly and the grade is high, surgical resection of the lesion plus postoperative adjuvant chemotherapy should be actively performed. Other better treatments are still being explored.
Gastrins ; Gastroscopy ; Humans ; Neuroendocrine Tumors ; Proton Pump Inhibitors ; Stomach Neoplasms

Gastric cancer is one of the most common malignant gastrointestinal tumors.Docetaxel alone or combination with other drugs can attenuate the progress of disease,prolong the overall response rate and the median overall survival rate in advanced gastric cancer.However,the incidence of toxicities is high.Moreover,there is no uniform standard for dosage and course for docetaxel treatment.Currently,its efficacy is not definite.

Objective The study was designed to comparatively analyze ultrasonic appearance,laboratory and pathological findings in autoimmune hepatitis(AIH),and their correlation.The clinical value of ultrasound in diagnosing autoimmune hepatitis was studied.Methods By retrospectively reviewing the ultrasonic images,pathological and laboratory results of 68 patients with autoimmune hepatitis admitted to the PLA 302 Hospital from 2014 to 2015,we tried to reveal the correlation between ultrasonic features and pathological and laboratory findings.Results The ultrasonic diagnosis of liver fibrosis was not statistically correlated with the features of pathological ″interface hepatitis″ and serological liver function test.But it was positively correlated with the features of pathological ″spotty necrosis″(r=0.5099,P ＜ 0.001).The ultrasonic features of ″cord-like structure″ and ″nodular change″ had statistically improved the classification of the degree of AIH fibrosis on ultrasonic diagnosis(t=3.9547,P ＜ 0.01).The ultrasonic feature of the change of ″liver size″ and ″morphology″ also have statistically improved the diagnosis of AIH fibrosis with ultrasonography(t=2.070,2.137,4.584,3.773,all P＜0.05).Conclusion Ultrasonic images could provide objective evidence in diagnosis of AIH and evaluation of fibrosis degree.

Objective To assess the relationship of CYP2C19 gene polymorphism with clopidogrel respon-siveness and the level of EETs in patients with ACS. Methods A total of 123 patients with ACS receiving aspirin combined with clopidogrel dual antiplatelet were enrolled. According to the results of CYP2C19 genotype,patients were divided into three groups:fast metabolic type ,medium metabolic type ,and slow metabolism type. The concentration of EETs and PAIR were compared between three groups. Logistic analysis was used to analyze the risk factors of LCR. Results There were differences statistically in level of EETs and PAIR among the three groups(P<0.05). Logistic analysis showed that the slow metabolism of CYP2C19 gene and lower EETs level were risk factors for LCR. The area under the ROC curve was 0.893(P < 0.05)by EETs level to predict the CYP2C19 genotype. Conclusion The slow metabolism of CYP2C19 gene was an independent risk factor for LCR,while the increase of plasma EETs level was a protective factor.

Objective Through the study of color Doppler ultrasound imaging, to explore the mechanism of portal vein thrombosis for patients with liver cirrhotic portal hypertension splenectomy and its influencing factors. Methods From January 2013 to December 2013, a total of 284 cases of patients with cirrhosis and portal hypertension plenectomy plus pericardial devascularization in 302 Hospital of PLA were reviewed. Color Doppler ultrasound technique was employed to record the thrombosis of portal vein, splenic vein and superior mesenteric vein before and after the surgical procedure. According to the occurrence of portal vein thrombosis after splenectomy, patients were divided into portal vein thrombosis group and non portal vein thrombosis group; the factors that may affect the formation of portal vein thrombus were analyzed by using Logistic regression. Results One hundred and twenty-nine cases of portal vein thrombosis occurred among the 284 patients with splenectomy, the incidence rate was 45.42% (129/284). Logistic regression analysis shows that inner diameters of splenic vein for the group with portal vein thrombosis are significantly different from that of the group without portal vein thrombosis (Z=2.034, P < 0.05), postoperative inner diameter of portal vein (Z=2.037, P<0.05), and prothrombin time (Z=-2.171, P<0.05) are significantly higher in the group with portal vein thrombosis, while preoperative platelet count is significantly lower in the group with portal vein thrombosis (Z=-2.146, P < 0.05); gender, preoperative hepatic artery flow velocity, and blood coagulation time are also the influencing factors of portal vein thrombosis (all P>0.05). Conclusion Color Doppler ultrasound technology can not only monitor, the thrombus formation in portal venous system post splenectomy, it can assess the risk factors of portal vein thrombosis post splenectomy.

Objective To compare the efficacy and safety of singular double antithrombotie therapy (DT) using warfarin plus clopidogrel and the combined antithrombotie therapy of 3-month triple antithrombotie therapy (TT) using warfarin, aspirinand clopidogrel and 9-month double antithrombotie therapy (DT) for the patients with atrial fibrillation undergoing PCI. Methods Ninety patients with atrial fibrillation undergoing PCI were randomly divided into two groups evenly: one group was treated with dual antithrombotic therapy group (DT) and the other group with the combined therapy, e. g. 3-month triple antithrombotie therapy (TT) and 9-month double antithrombotie therapy (DT + TT for short). All patients were followed-up by 12 months. The two groups were compared in terms of incidences of death , myocardial infarction , stroke , target-vessel revascularisation , stent thrombosis and bleeding adverse events. Results The incidences of myocardial infarction, stroke, target-vessel revascularisation , stent thrombosis and bleeding adverse events in the TT + DT group were all significantly lower than the DT group (P < 0.05). The follow-up on the safety indicated that the rate of bleeding in the TT +DT group was insignificantly higher than the DT group (P > 0.05). Conclusion There is no significant difference in safety between the two groups. However, the therapy of TT + DT is more effective.