AIM: To compare the clinical effectiveness of using multifocal defocus spectacle lenses, orthokeratology lenses, and single-vision spectacle lenses in patients with myopia and small-angle intermittent exotropia.METHODS: This retrospective study included 150 patients aged 8-15 years with basic intermittent exotropia, strabismus of -10△ to -20△ prism diopters(D)(block lenses), and spherical equivalents of -1.00 to -5.50 D, who visited our hospital from June 2021 to September 2022. They were selected and divided into three groups on a voluntary basis: the HAL group(50 patients with multifocal myopia defocus spectacle lenses), the OK lens group(50 patients with nighttime orthokeratology lenses), and the SVL group(50 patients with regular single-vision spectacle lenses). After wearing the lenses consistently, changes in axial length, prism diopters with the naked eye and lenses(prism at 33 cm), positive fusional vergence of blurred points, and near stereopsis were observed and compared among groups before intervention and after 1 a. The Newcastle control score(NCS)was used to evaluate the eye position control ability of the patients in the three groups.RESULTS: Before the intervention, the axial lengths of the HAL, OK lens, and SVL groups were 24.83±0.91, 24.93±0.97, and 24.98±0.68 mm, respectively(P>0.05). After 1 a, the axial lengths of the three groups were 25.02±0.90, 25.18±0.97, and 25.45±0.65, respectively(P<0.05). Compared with an increase of 0.47±0.30 mm in the SVL group after 1 a, the axial length of the HAL and OK lens groups increased by 0.19±0.06 and 0.25±0.21 mm, respectively(both P<0.05). Before intervention, the prism diopters of the HAL, OK lens, and SVL groups measured using the prism were -15.00△±3.12△, -14.34△±3.00△ and -14.06△±3.22△, respectively. After 1 a, the prism diopters of the three groups with lenses were -9.34△±3.84△, -18.42△±4.41△, and -19.58△±5.21△, respectively, which increased by 5.66△±2.13△, -4.08△±3.34△, and -5.52△±3.70△, respectively, compared with the preintervention values(P<0.05). Before intervention, the near stereopsis in the HAL, OK lens, and SVL groups were 89.20″±54.65″, 93.00″±52.54″, and 88.40″±55.31″, respectively(P>0.05). After 1 year, near stereopsis in the groups were 76.00″±20.40″, 81.20″±18.91″, and 100.60″±51.41″, respectively(P<0.05). The positive fusional vergence(fuzzy point)of the three groups was 15.04±1.97, 15.14±1.67, and 14.62±1.47, respectively, before intervention(P>0.05), and it was 17.10±2.02, 13.12±1.41, and 13.26±2.45, respectively, after 1 a(P<0.05). In addition, the eye position control in the HAL group was significantly better than that in the OK lens and SVL groups after wearing lenses for 1 a(P<0.05).CONCLUSION: For patients with myopia and small-angle intermittent exotropia, wearing HAL can effectively control changes in strabismus and axial length compared with OK lenses and SVL, particularly for better control of strabismus, whereas wearing OK lenses or SVL would result in exotropic drifts. Stereopsis and positive fusional vergence were significantly improved in the HAL group.

AIM: To analyze the diagnostic value of optical coherence tomography angiography(OCTA)in evaluating the parameters of foveal avascular zone(FAZ)in early diabetic retinopathy(DR).METHODS: Retrospective study. A total of 209 cases(209 eyes)of type 2 diabetes mellitus(T2DM)with DR admitted to our hospital from June 2019 to December 2022 were selected as DR group. The DR group was divided into three groups, with 115 cases(115 eyes)in mild group, 54 cases(54 eyes)in moderate group, and 40 cases(40 eyes)in severe group according to stage. Another 100 cases(100 eyes)of T2DM patients without DR were selected as No-DR group, and 70 cases(70 eyes)of healthy people were selected as control group for physical examination at the same time, all of whom underwent OCTA examination. The DR group was enrolled according to the disease degree, one eye was randomly taken for the study if the degree in both eyes was the same, while the control group and the No-DR group were randomly selected for one eye to be included in the study. The perimeter of the foveal avascular area(PERIM), FAZ transverse diameter, FAZ vertical diameter, FAZ area, macular fovea retinal thickness(MFRT), acircularity index(AI), full layer retinal blood flow density within a range of 300 μm around the FAZ(FD-300), and changes in FAZ vascular density(VD)levels among different groups of subjects were compared. Furthermore, Pearson correlation analysis was used to determine the correlation between general data and FAZ related indicators, and receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of macular FAZ indicators for DR.RESULTS: The levels of FBG, MFRT, FAZ area, and PERIM in patients with mild, moderate, and severe DR were significantly higher than those in the No-DR group and the control group, while the levels of AI and VD were significantly lower than those in the No-DR group(all P<0.05); patients in the No-DR group, mild DR group, moderate DR group, and severe DR group had significantly higher cystatin C, FAZ transverse diameter, and FAZ vertical diameter than the control group, while FD-300 vascular density was significantly lower than the control group(all P<0.05); the MFRT was positively correlated with age(r=0.295, P=0.001); The AI and VD was negatively correlated with age(r=-0.296, -0.235, all P<0.05); the area under the curve(AUC)of MFRT, FAZ area, PERIM, AI, and VD for the diagnosis of DR were 0.745, 0.738, 0.696, 0.792, and 0.847, respectively.CONCLUSION:The structure and microcirculation of FAZ can be changed in DM patients, and the related parameters of FAZ have certain value in the diagnosis of early DR.

Implementation strategies are targeted interventions aimed at promoting the adoption, implementation, and sustainment of research findings or evidence-based practices in routine healthcare. If implementation strategies can precisely match implementation barriers and facilitators, the likelihood of successful implementation will increase. The CFIR-ERIC matching tool, which can match corresponding ERIC implementation strategies based on CFIR barriers, is a convenient and direct tool for developing implementation strategies. This paper provides a detailed overview of the origins and development of the CFIR-ERIC matching tool, outlines its contents and usage, and illustrates how to apply the tool to develop implementation strategies by using a brief smoking cessation intervention project as an example. The paper also discusses the advantages and limitations of using this tool for developing implementation strategies, with the aim of providing methodological reference for other researchers.

Objective A rat model of pulmonary fibrosis was constructed using a single or two intratracheal drops of bleomycin(BLM)and the modeling rate and stability of the two modeling modalities were compared.Methods A total of 150 specific pathogen-free SD rats were divided randomly into blank control(control),single intratracheal drop of bleomycin(BLM-S),and two intratracheal drops of bleomycin(BLM-M)groups.Rats in the BLM-S group received a single dose of 3 mg/kg BLM by noninvasive intratracheal instillation,and rats in BLM-M group received 3 mg/kg BLM on day 1 and BLM 2 mg/kg on day 14.Rats in the control group were given intratracheal instillation of 0.9％sodium chloride(1 mL/kg).The rats were euthanized on days 28,42,56,and 84 after modelling,respectively.Deep inspiratory capacity(IC),vital capacity(VC),static lung compliance(Cchord),and dynamic lung complication(Cdyn)were measured in all rats.Pathological changes in lung tissue were observed,and the extent of alveolitis and fibrosis was graded.Collagen-Ⅲ(COL-Ⅲ)expression in rat lung tissue was detected by immunohistochemistry.Results(1)The survival rates in the control,BLM-S,and BLM-M groups were 100％,80％,and 66％,respectively.Rats in the BLM-S and BLM-M groups had significantly lower body weights on days 14～42 compared with the control group(P＜0.05,P＜0.01),and rats in the BLM-M group had significantly lower body weight on days 28～42 than rats in the control and BLM-S groups(P＜0.05,P＜0.01).(2)Regarding lung function,IC,VC,Cchord,and Cdyn were all markedly decreased in the BLM-S group compared with the control group(P＜0.05,P＜0.01)and IC,VC,and Cchord were significantly decreased in the BLM-M group(P＜0.05,P＜0.01)on day 28.IC,VC,and Cchord were significantly decreased in rats in the BLM-S group on day 42(P＜0.05,P＜0.01),and were also significantly decreased in rats in the BLM-M group on days 42～84(P＜0.05,P＜0.01).(3)In terms of lung pathology,inflammatory infiltration and fibrous cords appeared in the BLM-S group from days 28～84 and then gradually decreased(P＜0.05,P＜0.01),while fibrosis and alveolitis were relatively stable in the BLM-M group(P＜0.05,P＜0.01).(4)COL-Ⅲ expression levels in lung tissue were significantly higher in rats in the BLM-S and BLM-M groups compared with the control group(P＜0.05,P＜0.01),and the COL-Ⅲ content in the BLM-S group was significantly lower at 42～84 days than at 28 days(P＜0.05).Conclusions Both method are capable of effectively creating pulmonary fibrosis models.The single-dose approach is straightforward,has a lower death rate,and the degree of fibrosis is clearly visible by day 28,but progressively recovers after 42 days.In contrast,the two-dose instillation model has a greater success rate and better stability,with over half the rats still exhibiting visible fibrosis on day 84.

Objective To compare the success rate and stability of rat pulmonary fibrosis(PF)models induced by intratracheal instillation of different doses of bleomycin(BLM).Methods One hundred and fifty Sprague Dawley rats were divided randomly into control,low-dose BLM 3 mg/kg(BL-L),and high-dose BLM 5 mg/kg(BL-H)groups.General status,mortality,and weight changes were observed,and the lung inspiratory capacity(IC),vital capacity(VC),chord compliance(Cchord),and dynamic compliance(Cdyn)were detected on days 28,42,56,and 84.Lung coefficients were recorded and pathological changes in lung tissue were observed by hematoxylin and eosin and Masson staining.The lung hydroxyproline(HYP)content was detected and collagen type Ⅲ(COL Ⅲ)was detected by immunohistochemistry.Results The mortality rates in the BL-L and BL-H groups were 20％and 28％,respectively.Body weight was significantly lower in the BL-L group compared with the control group on days 0～56,and weight recovery after day 56.Body weight was significantly lower in the BL-H group compared with the control and BL-L groups from days 0～56(P＜0.01).Regarding lung function,IC,VC,Cchord,and Cdyn were significantly lower in the BL-L group compared with the control group on day 28(P＜0.01,P＜0.05),and IC and Cdyn were significantly lower in the BL-H group(P＜0.01).IC,VC,and Cchord were significantly decreased in the BL-L group on day 42(P＜0.01,P＜0.05),while IC,VC,Cchord,and Cdyn were significantly decreased in the BL-H group(P＜0.01,P＜0.05),and IC,VC,and Cchord were significantly lower compared with in the BL-L group(P＜0.01).Cchord was significantly lower in the BL-H group compared with the control and BL-L groups on day 56(P＜0.01).The lung coefficients on day 28 were significantly higher in the BL-L and BL-H groups compared with the control group(P＜0.01),and were significantly higher in the BL-H group from days 42～56 compared with the BL-L and control groups(P＜0.01).Regarding lung histopathology and immunohistochemistry,inflammatory infiltration,fibrotic streaks,and COL Ⅲ expression were observed in the BL-L group from days 28～56,and almost complete disappearance of the fibrotic lesions on day 84.In contrast,fibrotic lesions could be observed from days 28～84 in the BL-H group,with significantly elevated COL Ⅲ expression compared with the control group(P＜0.01).The HYP content was significantly higher in the BL-L group compared with the control group from days 28～42(P＜0.05,P＜0.01),and then gradually decreased,and the HYP content was significantly higher in the BL-H group than in the control group from days 28～84(P＜0.01).Conclusions Both 3 and 5 mg/kg BLM can successfully induce PF rat models.Rats treated with 3 mg/kg BLM developed fibrosis on day 28,which lasted until day 42 and then gradually recovered.Rats treated with 5 mg/kg BLM developed fibrosis on day 28,and the degree of fibrosis was more severe with the higher compared with the lower dose,with stable fibrotic lesions up to day 56 and moderate-to-severe fibrosis still present in half of the rats until day 84.

Abstract To investigate the differential diagnostic value of Chinese thyroid imaging reporting and data system (Chinese⁃TIRADS , C ⁃TIRADS) and the combination with ultrasonic elastic strain rate(SR)and BRAFV600E gene detection in the diagnosis of benign and malignant thyroid nodules. A total of 137 patients with 142 thyroid nodules were analyzed retrospectively , which included observing two⁃dimensional ultrasound and elastic image characteris tics and recording the elastic strain rate. The malignant risk of thyroid nodules was stratified by C ⁃TIRADS. To use pathology results as the gold standard , the efficacy of the above methods in diagnosing the nodules was evaluated. The diagnostic efficacy of C ⁃TIRADS combined with elastic strain rate in the diagnosis of thyroid nodules was higher than that of C ⁃TIRAsignificant (P < 0. 05) . There was no statistical difference between C ⁃TIRADS and BRAFV600E gene detection (> 0. 05)

Objective:To evaluate the clinical application value of MR amide proton transfer weighted imaging (APTWI) in predicting the pathological grade of brainstem glioma (BSG).Methods:The data of 41 BSG patients in Beijing Tiantan Hospital, Capital Medical University from August 2019 to June 2020 who underwent both MRI and APTWI 2 weeks before surgery and had pathological grading results were retrospectively analyzed. According to the pathological results, 41 patients were classified into high-grade BSG (20 patients) and low-grade BSG (21 patients). Combined with conventional MR images, the signal intensity (%) of amide proton transfer (APT) in the parenchymal area of the tumor was obtained on APTWI images. χ 2 test or independent sample t-test was used to analyze the differences in gender distribution, age and APT signal intensity between patients with high and low grade BSG. Receiver operating characteristic (ROC) curve was drawn to predict the efficacy of APT signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold; the predictive ability of APT signal intensity was analyzed in combination with Hosmer-Lemeshow goodness of fit test. Results:There was no significant difference in age [(23±18) years, (20±17) years, t=0.97, P=0.340] and gender distribution (9/11, 9/12 for males/females, χ 2=0.02, P=0.890) between high-grade and low-grade BSG patients. The APT signal intensity of high-grade BSG [(3.9±0.9)%] was significantly higher than that of low-grade BSG [(2.8±0.9)%], and the difference had statistical significance ( t=4.16, P<0.001). The area under the ROC curve of APT signal intensity to distinguish high-grade and low grade BSG was 0.836, and with 2.85% as the optimal diagnostic threshold of APT signal intensity, its sensitivity for the diagnosis of high-grade BSG was 90.0% and specificity was 71.4%. The Hosmer-Lemeshow test showed that APTWI had a good predictive ability for BSG grade (χ 2=13.33, P=0.101). Conclusion:APTWI can be applied in distinguishing high grade BSG from low grade BSG, and has clinical value in predicting glioma grading.

Objective:To explore the application effect of family-centered empowerment model (FCEM) in rehabilitation nursing of children with femoral shaft fractures treated by skin traction.Methods:A retrospective case-control study was conducted to analyze the clinical data of 107 children with femoral shaft fractures treated with skin traction in Anhui Children′s Hospital from April 2019 to October 2021, including 67 males and 40 females; aged 1.5-5.0 years [2.8(2.0, 3.5)years]. Fracture types included oblique fracture ( n=50), comminuted fracture ( n=26), transverse fracture ( n=14) and spiral fracture ( n=17). FCEM nursing was implemented in 55 patients (family empowerment group) and routine home rehabilitation nursing guidance was performed in 52 patients (routine nursing group). The face, legs, activity, cry, consolability (FLACC) behavioral score on admission and at days 1, 3 and 7 after skin traction, treatment compliance rate at 1 month after skin traction, complication rate at 1 month after skin traction, length of hospital stay and fracture healing time were compared between the two groups. Results:All patients were followed up for 12-18 weeks [13.4(12.7, 13.9)weeks]. There was no significant difference in FLACC behavioral score between the two groups on admission ( P>0.05). The FLACC behavioral score was (4.0±0.7)points,(3.4±0.6)points and (2.4±0.6)points in family empowerment group at days 1, 3 and 7 after skin traction, lower than (4.8±0.7)points, (3.9±0.8)points and (3.3±0.5)points in routine nursing groups (all Ρ<0.01). One month after skin traction, treatment compliance was excellent in 51 patients, good in 4, poor in 0, with treatment compliance rate of 92.7% (51/55) in family empowerment group, and was excellent in 40 patients, good in 9, poor in 3, with treatment compliance rate of 76.9% (40/52) in routine nursing group ( Ρ<0.05). The complication rate was 5.4% (3/55) in family empowerment group, lower than 21.2% (11/52) in routine nursing group ( Ρ<0.05). The length of hospital stay and fracture healing time were (15.6±0.3)days and (7.1±0.8)weeks in family empowerment group, shorter than (16.8±0.3)days and (8.2±0.4)weeks in routine nursing group (all Ρ<0.01). Conclusion:For children with femoral shaft fractures treated by skin traction, nursing using FCEM can alleviate pain, improve treatment compliance, reduce complication rate, reduce hospital stay and shorten fracture healing time.

Objective:To investigate the expression and clinical significance of long non-coding RNA (lncRNA) H19 and lncRNA maternally expressed gene 3 (MEG3) in the serum of patients with gastric cancer (GC).Methods:A total of 87 GC patients admitted to the First People′s Hospital of Suqian (July 2017 to August 2018) were selected as the GC group, 51 patients with benign tumors as the benign tumor group, and 40 healthy people with physical examination as the healthy control group. The expression levels of lncRNA H19 and lncRNA MEG3 in serum were measured; the relationship between the expression levels of the two and clinicopathological features and prognosis of patients with GC was analyzed.Results:The levels of serum lncRNA H19 in healthy control group, benign tumor group and GC group were gradually increased, and lncRNA MEG3 level was gradually decreased ( P<0.05); the serum lncRNA H19 level in GC group was related to tumor invasion depth, tumor node metastasis (TNM) stage and lymph node metastasis. The level of lncRNA MEG3 was related to the degree of differentiation, TNM stage and lymph node metastasis ( P<0.05). Among the 87 GC patients , 63 patients were followed up for 13-32 months with an average of (23.54±4.18)months. Kaplan Meier survival curve showed that the overall survival rate of high serum lncRNA H19 group and low serum lncRNA MEG3 level group was significantly lower than that of low serum lncRNA H19 level group and high serum lncRNA H19 level group. Multivariate Cox regression analysis showed that lncRNA H19 ( HR=3.442, 95% CI=0.089-23.421) was an independent prognostic factor for GC patients, and lncRNA MEG3 ( HR=4.386, 95% CI=0.934-20.596) was a protective factor ( P<0.05); receiver operating characteristic (ROC) curve showed that the sensitivity, specificity and accuracy of serum lncRNA H19+ lncRNA MEG3 [area under curve (AUC)=0.922, 95% CI=0.861-0.962] were higher than those of serum lncRNA H19 (AUC=0.840, 95% CI=0.771-0.904) and lncRNA MEG3 (AUC=0.830, 95% CI=0.753-0.890). Conclusions:The level of serum lncRNA H19 in GC patients is significantly increased, and the level of lncRNA MEG3 is significantly reduced, which is closely related to tumor occurrence, development and prognosis. Combined detection of the two can enhance the diagnostic value of GC.

Objective To explore the current situation and requirements of the health management services among the middle-aged and elderly people in Hainan province for optimizing the health management service pattern. Methods The random sampling method was adopted to perform the survey and analysis on the current situation and requirements of the health management services among 600 middle-aged and elderly people by using the mode of questionnaire combined with interview. Results Totally 575 respondents completed the questionnaire. 43.1% of respondents could correctly understand the concept of health, 40.5% of them thought that "Health is the condition without disease" ;the main ways for getting the health knowledge by these people were mainly joining the intercommunication meeting of health management (97. 2%), phone counseling (94. 4%) and brochures (90.3%) ;the requirements of the health management service mainly focused on the middle age and elderly people aged 45- 59 years old. The most needed health management service items were the mental health service (99.0 %), cultural entertainment service(97.4 %) and health care recovery(84 %). The health management requirements had no statistical difference compared with the gender (x2 = 0. 678, P= 0. 712), cultural degree (x2 = 5. 584, P = 0. 471 ) and medical insurance situation (x2 = 3. 886, P = 0. 420) ;but compared with the age, the difference was statistically significant (x2 = 9. 697, P = 0.04). Conclusion The consciousness of health management among middle age and old people needs to be increased,the health management information platform construction and propaganda promotional efforts should be strengthened, the cooperation between government and enterprise should be strengthened, the pertinence of the health management service should be enhanced and the related policy laws and regulations should be perfected.