The intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is currently the first-line therapy for retinopathy of prematurity (ROP) in clinical practice.This therapy has several advantages, including ease of operation, rapid onset of action, and minimal adverse reactions.However, the high reactivation rate observed in clinical applications limits its utility.Understanding reactivation characteristics is crucial for patient management and clinical trial design.The International Classification of Retinopathy of Prematurity (Third edition) updated the definition of reactivation and related concepts.This article summarizes the clinical manifestations and mechanisms of ROP reactivation after anti-VEGF therapy in recent studies and analyzes high-risk factors associated with reactivation, including those related to the infant, the disease, and the medication.The goal is to provide guidance for the early identification, prevention, and intervention in clinical practice.Nevertheless, significant clinical controversies remain regarding the prevention and retreatment of ROP reactivation.Future research should accumulate more evidence-based medical data and conduct large-scale prospective studies to further standardize diagnostic and treatment processes.

The intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is currently the first-line therapy for retinopathy of prematurity (ROP) in clinical practice.This therapy has several advantages, including ease of operation, rapid onset of action, and minimal adverse reactions.However, the high reactivation rate observed in clinical applications limits its utility.Understanding reactivation characteristics is crucial for patient management and clinical trial design.The International Classification of Retinopathy of Prematurity (Third edition) updated the definition of reactivation and related concepts.This article summarizes the clinical manifestations and mechanisms of ROP reactivation after anti-VEGF therapy in recent studies and analyzes high-risk factors associated with reactivation, including those related to the infant, the disease, and the medication.The goal is to provide guidance for the early identification, prevention, and intervention in clinical practice.Nevertheless, significant clinical controversies remain regarding the prevention and retreatment of ROP reactivation.Future research should accumulate more evidence-based medical data and conduct large-scale prospective studies to further standardize diagnostic and treatment processes.

Objective:To evaluate the clinical features of acute macular neuroretinopathy (AMN) associated with COVID-19.Methods:A retrospective case series studies. A total of 12 eyes of 8 patients diagnosed of AMN associated with COVID-19 at Peking University People’s Hospital from December 5, 2022 to January 5, 2023 were included. Of the 8 patients, 2 were male (4 eyes) and 6 were female (8 eyes), with an average age of (29.38±8.60) years. All patients underwent best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography (OCT), and infra-red fundus photography (IR). After definite diagnosis, the patients were given symptomatic treatment such as local vasodilation, anti-inflammatory and systemic circulation improvement and nutritional nerve. Follow-up time was 21-30 days weeks. Clinical manifestations, OCT and IR image characteristics, and treatment outcomes were retrospectively analyzed.Results:The time from diagnosis of COVID-19 to the onset of ocular symptoms was (3.00±0.93) days. Among 12 eyes, 6 had complaints of paracentral scotoma, with 2 of them accompanied by visual acuity loss; and 6 had complaints of dark shadows in the vision, with 2 of them accompanied by visual acuity loss. At the initial examination, 2 eyes had a BCVA of less than 0.05, 2 eyes had a BCVA between 0.4 and 0.6, and 8 eyes had a BCVA between 0.8 and 1.0. At the last follow-up, visual symptoms improved in 7 eyes and remained unchanged in 5 eyes. Fundus color photography showed reddish-brown lesions in the macular area. Spectral-domain OCT revealed localized thickening and strong reflection of the outer plexiform layer (OPL) in the macular area, patchy strong reflections in the outer nuclear layer (ONL), and varying degrees of local discontinuity in the adjacent external limiting membrane, ellipsoid zone/interdigitation zone (EZ/IZ), with reduced local reflection in the adjacent retinal pigment epithelium layer in 2 eyes. The strong reflection area of the ONL on corresponding structural OCT was observed more clearly as a lesion range with strong reflection on en-face OCT. The incomplete structure of the EZ/IZ band was observed more clearly as a lesion range with weak reflection on en-face OCT. IR showed several clear-bordered and weakly reflecting lesions at the center of the macula, with the tip pointing to the fovea.Conclusions:AMN associated with COVID-19 tends to occur in young females. The OCT findings of AMN are characterized by strong reflections in the OPL and ONL, and lesion ranges can be observed more clearly at different levels using en-face OCT. The lesions on IR appear as weak reflections.

Background and aim:Real-world data on the effectiveness and safety of treatment with the direct-acting antiviral agent-based regimen are limited on the Chinese mainland.The aim of this study was to conduct a multicenter,prospective,real-world study of ombitasvir/paritaprevir/ritonavir(OBT/PTV/r)combined with dasabuvir(DSV)in hepatitis C virus(HCV)genotype 1b-infected non-cirrhotic or compensated cirrhotic Chinese adult patients. Materials and methods:Genotype 1b-infected patients were enrolled at eight sites in China.Patients received 25/150/100 mg of OBT/PTV/r once daily combined with 250 mg of DSV twice daily for 8 weeks or 12 weeks.Sustained virological response at 12 weeks post-treatment(SVR12)and the incidence of adverse events were assessed.We have also evaluated the effect of intensive questioning of patients who were overdue for SVR12 testing.Intention-to-treat(1TT)and modified 1TT(mITT)populations were used in the analysis. Results:One hundred forty patients were included,among whom 90.0％(126/140)were newly diag-nosed,9.3％(13/140)had compensated cirrhosis,92.9％(130/140)received 12 weeks of treatment,and 7.1％(10/140)received 8 weeks of treatment.In the mITT population,the virological response rate at week 4 was 96.4％(108/112),and at the end of treatment was 100％(102/102).Among these patients,139 patients completed 12 weeks of treatment,and 73 patients were followed-up.All followed-up patients achieved SVR12.There was no adverse event-related discontinuation.Serious adverse events during treatment were reported in two(1.4％)patients,and none were considered to be drug-related.Sixty-six(47.1％)patients did not return to receive the HCV RNA test at 12 weeks post-treatment. Conclusions:The rate of SVR12 was consistent with Phase Ⅲ clinical studies.OBT/PTV/r combined with DSV showed effectiveness in Chinese adult patients,and both tolerability and safety profile were favorable.However,patient compliance should be further improved in the real world.

Objective To observe the effects of melatonin (MT) on the expression of heme oxygenase-1 (HO-1),phosphorylated adenine dinucleotide quinone oxidoreductase-1 (NQO-1) and nuclear factor erythroid-2-related factor 2 (Nrf2),so as to explore the mechanism of MT's action in the Nrf2-ARE signaling pathway.Methods A total of 72 Sprague-Dawley rats were randomly divided into a control group,an injury group and a melatonin group,each of 24.T11-T12 acute SCI was induced in the injury and melatonin groups using the modified Allen's method.Ten minutes after the injury,equal amounts of absolute ethyl alcohol and melatonin were intraperitoneally injected into the rats in the injury and melatonin groups.For the control group,the vertebral plate was cut to expose the T11-T12 spinal cord without any injury of the nerves.Six rats from each group were randomly selected for sacrifice at 6,12 and 24 hours after the operation,and T11-T12 spinal cord specimens were collected.The spinal cord injury and inflammatory response were observed using haematoxylin eosin staining.The expression of HO-1,NQO-1 and Nrf2 was examined using immunofluorescence,while the expression of HO-1,NQO-1 and Nrf2 protein and mRNA were detected using RT-PCRs.Results The neuronal cells in the spinal cords of the control rats were of normal shape,without edema,necrosis or obvious hemorrhagic foci.Hemorrhagic foci,significantly more inflammatory cells and some spinal cord neurons with edema and necrosis were observed in the injury group.However,significantly fewer hemorrhagic spots and cells with edema were found in the melatonin group compared with the injury group.The average expression of HO-1,NQO-1 and Nrf2 protein and mRNA was significantly higher in the melatonin group than in the other two groups.The levels in the injury group were also significantly higher than in the control group 12 and 24 hours after the experiments.Immunofluorescence showed that the greatest number of cells with HO-1,NQO-1 and Nrf2 was found in the melatonin group,followed by the injury group and then the control group,with significant differences among all 3 groups.Conclusion Melatonin can promote the expression of HO-1,NQO-1 and Nrf2 in rats with acute spinal cord injury,which might be related with its activating the Nrf2-ARE signaling pathway.

Objective To establish a mathematical model foRestimating the probability of malignancy in patients with solitary pulmonary nodule,and to verify the accuracy of this model.Methods A retrospective cohort study included 405 patients (220 males and 174 females) with definite pathological diagnosis of SPN from January 2008 to SeptembeR2013 (group A).Clinical and imaging features were analyzed,and a clinical prediction model was built with multivariate Logistic regression analysis.The otheR168 SPN patients (group B) with definite pathological diagnosis from OctobeR2013 to SeptembeR2015 were selected to estimate the accuracy of the model.Calibration of this model was assessed by Hosmer-Lemeshow (H-L) test.The area undeRcurve (AUC) afteRreceive operating characteristic (ROC) curve was drawn.Results Logistic regression analysis showed that age,previous canceRhistory,family history of cancer,diameter,speculation,lobulation,border,pleural retraction sign were independent predictors of malignancy in SPN patients (P<0.05).The sensitivity in group B was 94.7%,specificity was 76.4%,positive predictive value was 89.2%,and negative predictive value was 87.5%.The AUC of this model was 0.809±0.017.Conclusion The clinical prediction model that we established by retrospective study has a higheRclinical value in predicting the probability of malignancy oRbegin in patients with solitary pulmonary nodules.

Objective To establish a mathematical model foRestimating the probability of malignancy in patients with solitary pulmonary nodule,and to verify the accuracy of this model.Methods A retrospective cohort study included 405 patients (220 males and 174 females) with definite pathological diagnosis of SPN from January 2008 to SeptembeR2013 (group A).Clinical and imaging features were analyzed,and a clinical prediction model was built with multivariate Logistic regression analysis.The otheR168 SPN patients (group B) with definite pathological diagnosis from OctobeR2013 to SeptembeR2015 were selected to estimate the accuracy of the model.Calibration of this model was assessed by Hosmer-Lemeshow (H-L) test.The area undeRcurve (AUC) afteRreceive operating characteristic (ROC) curve was drawn.Results Logistic regression analysis showed that age,previous canceRhistory,family history of cancer,diameter,speculation,lobulation,border,pleural retraction sign were independent predictors of malignancy in SPN patients (P<0.05).The sensitivity in group B was 94.7%,specificity was 76.4%,positive predictive value was 89.2%,and negative predictive value was 87.5%.The AUC of this model was 0.809±0.017.Conclusion The clinical prediction model that we established by retrospective study has a higheRclinical value in predicting the probability of malignancy oRbegin in patients with solitary pulmonary nodules.

Objective To observe the ultrastructure of blood-brain barrier in the nude mouse model of brain me-tastases from lung cancer by transmission electron microscopy using lanthanum nitrate tracing.Methods PC-9 cells (1 × 106/0.1 mL) in logarithmic phase were respectively injected into six nude mice ( model group) selected from eight nude mice randomly via the left ventricle, the other two mice without any treatment as the control group.The general status of the mice was observed after implantation.In the fourth week all the mice were sacrificed and brain tissue samples were taken and prepared for transmission electron microscopic observation using lanthanum nitrate tracing.besides, the lung and brain were removed and stained with HE to detect the presence of tumor metastasis.Results Mice in the model group began to lose weight almost simultaneously in the third week and became moribund slowly, and were all sacrificed at the fourth week when showing clear signs of cachexia.At autopsy, the thoraxes were clear, with normal lungs.Histology showed evidence of brain metastasis in all the six mice.The electron microscopy showed that lathanum nitrate tracer was escaped from the capillaries and diffusely or sparsely distributed in the brain tissues of the model group mice, however lathanum nitrate tracer was still confined in the capillary lumen in the mice of control group.Conclusions The diffuse lathanum nitrate tracer in the brain parenchymal tissue indicates the impairment of blood-brain barrier in the nude mouse model of lung cancer brain metastasis and the formation of these metastases is accompanied with the destruction of blood brain barrier.

OBJECTIVE:To establish the HPLC fingerprints for Sini decoction and compare the differences of compositions of Sini decoction prepared by traditional decoction and modern machine decoction. METHODS:HPLC was performed on the column of Kromasil C18 with mobile phase of acetonitrile-0.1% phosphoric acid(gradient elution)at a flow rate of 1.0 ml/min,the detec-tion wavelength was 235 nm,column temperature was 30 ℃,and injection volume was 10 μl. The HPLC fingerprints of 10 batch-es of Sini decoction were determined with reference peak of liquiritin peaks,and common peak identification and similarity evalua-tion were conducted by using Chromatographic Fingerprint Similarity Evaluation System(2004 A edition). RESULTS:There were 18 common peaks and the similarity was no less than 0.982. According to the verification,the fingerprint of 10 batches of Sini de-coction showed good similarity with reference fingerprint,and the similarity of 10 batches of Sini decoction was high,which was prepared by the 2 methods. CONCLUSIONS:The established fingerprint is specific and stable,and can provide reference for quali-ty evaluation and control for Sini decoction;and there are no obvious differences in the main chemical compositions of Sini decoc-tion prepared by traditional decoction and modern machine decoction.

OBJECTIVE:To compare cost-effectiveness of Xiyanping injection and Ribavirin injection in the treatment of com-mon type hand-foot-mouth disease (HFMD) in children,and to provide evidence for rational drug use in the clinic. METHODS:The literatures about Xiyanping injection in the treatment of common type HFMD in children using Ribavirin injection as control were retrieved from CNKI,VIP,Wanfang,PubMed,Cochrane library and other databases. The decision tree was established with TreeAge Pro 2011 software to conduct cost-effectiveness analysis. Tornado diagram was used to analyze sensitive factors;single fac-tor and double factors sensitivity analysis were also conducted. RESULTS & CONCLUSIONS:The total cost of Xiyanping injection and Ribavirin injection were 2 887.53 and 3 058.72 yuan,respectively. The total effective rates were 92.49% and 78.12%. Xiyan-ping injection shows cost-effectiveness advantage. The results of cost-effectiveness analysis were supported by sensitivity analysis.