Abstract The prevention and control of myopia in Chinese children and adolescents has become a major public health issue. While maintaining increased outdoor activity as a cornerstone intervention, there is an urgent need to explore new complementary approaches that can be effectively implemented in both indoor and outdoor settings. In recent years, environmental spatial frequency has gained increasing attention as one of the key environmental factors influencing the development and progression of myopia. Both animal studies and human research have confirmed that indoor environments lacking mid to high spatial frequency components, often characterized as "visually impoverished", can promote axial elongation and myopia through mechanisms such as disruption of retinal neural signaling, impaired accommodative function, and altered expression of related molecules. Based on the scientific consensus, it is recommended that "enriching of environmental spatial frequency" should be integrated into the myopia prevention and control framework. Following the principles of schoolled organization, family cooperation, community involvement, and student participation, specific measures are put forward in three areas：optimizing school visual settings, improving home spatial environments, and promoting healthy visual behavior. The aim is to create "visually friendly" indoor environments as an important supplement to outdoor activity, thereby providing a novel perspective and strategy for comprehensively advancing myopia prevention and control among children and adolescents.

Objective: To investigate the changes of dentin surface and the effects of different surface treatments on the rebonding effect following non-destructive restoration removal by an Er:YAG laser and to provide reference for oral clinical operation Methods: This study was approved by the ethics review committee of the unit. Using computer-aided design and computer-aided manufacturing (CAD/CAM) technology, 102 zirconia specimens (4 mm × 4 mm × 1.5 mm) were fabricated. In total, 110 impacted third molar teeth were extracted, and 102 dentine blocks (4 mm × 4 mm × 2 mm) were prepared. The zirconia specimen and dentin blocks were bonded with resin cement before removal with an Er: YAG laser. Three disassembled dentin blocks were randomly selected, and the components of dentin surface elements were analyzed by energy dispersive X-ray spectroscopy (EDX). The removed dentin blocks were randomly divided into three groups (n = 33) based on the different surface treatments: control group (no treatment), sandblasting group (50 μm, Al2O3 sandblasting), and laser irradiation group (Er: YAG laser irradiation, parameters were set to 10 Hz, 60 mJ, 0.6 W). Three dentin blocks were randomly selected in each group for scanning electron microscopy (SEM) observation, and the residual resin on dentin surface of remaining 30 dentin blocks in each group were observed under an optical microscope at 20 times magnification. Scores were obtained using the adhesive remnant index (ARI) method. Three groups of dentin blocks (n = 30) that underwent different surface treatments were rebonded with resin cement according to standard procedures and then divided into two subgroups for aging (n = 15). One subgroup was subjected to a 37 ℃ water bath for 24 h, and the other subgroup was subjected to 5 000 thermal cycles after a 37 ℃ water bath for 24 h, and the micro-shear bonding strength of each group was measured. The microshear bonding strength of each group was measured, and fracture modes were analyzed. The differences of dentine surface ARI between the three groups, as well as the inter-group differences in fracture mode, and bonding strength, and the intra-group differences before and after aging were compared between the three groups. Results: When zirconia was removed by Er: YAG laser, there was no obvious damage on the dentin surface, but C and Si elements in dentin increased significantly. After different surface treatments, the ARI scores of the sandblasting and laser irradiation groups were lower than those of the control group (P<0.05), while ARI was not significantly different between the sandblasting and laser irradiation groups (P>0.05). The dentin surface morphology was also different. There was a large amount of residual resin on the dentin surface of the control group. In the sandblasting group, the residual resin was lower, the dentin surface was rough, and the dentin tubules were visible. A large amount of residual resin was observed on the dentin surface of the laser irradiation group. After 24 h of water bath at 37 ℃, the bonding strengths of the control group, sandblasting group, and laser irradiation group were (6.13 ± 2.40) MPa, (9.39 ± 2.00) MPa, and (5.85 ± 1.44) MPa, respectively, and the bonding strength of the sandblasting group was significantly higher than that of the other two groups (P<0.05). After being subjected to 24 h of water bath at 37 ℃ and 5 000 thermal cycles, the bonding strengths of the control group, sandblasting group, and laser irradiation group were (5.39 ± 0.83) MPa, (8.45 ± 1.20) MPa and (4.84 ± 1.43) MPa, respectively. The bonding strength of the sandblasting group was significantly higher than that of the other two groups (P<0.05). There was no significant difference between the control group, sandblasting group, and laser irradiation group before and after 5 000 thermal cycles following 24 h of water bath at 37 ℃ (P>0.05). In the control group, sandblasting group, and laser irradiation group, cohesive fracture was not observed. The fracture mode was mainly adhesive fracture. Before and after 5 000 thermal cycles, the frequency of mixed fracture in the sandblasting group was significantly higher than that in the other two groups (P<0.05). Conclusion Er: YAG laser removal of zirconia does not damage dentin, but a large amount of resin remains on the dentin surface after removal. The sandblasting process can effectively remove these residual resins, thereby improving the dentine rebonding effect.

OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy in the treatment of early-stage triple-negative breast cancer （TNBC）. METHODS A systematic search was conducted in PubMed， Embase， Cochrane Library， CNKI， and Wanfang Data to collect randomized controlled trials （RCT） on the use of immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy （experimental group） versus neoadjuvant chemotherapy and adjuvant chemotherapy （control group） in the treatment of TNBC. After literature screening， data extraction and literature quality evaluation， meta-analysis was performed using Stata 17.0. RESULTS A total of 5 RCT involving 1 498 patients were included. The meta-analysis results showed that the pathological complete response rate （pCR） [RR＝1.34， 95%CI （1.09， 1.63）， P＝0.03]， pCR in patients with positive programmed death-1 （PD-1） and its ligand （PD-L1） [RR＝1.33， 95%CI （1.16， 1.51）， P＝0.01]， pCR in patients with positive lymph nodes [RR＝ 1.56， 95%CI （1.27， 1.93）， P＝0.01]， the incidence of grade 3-4 adverse events （AEs） [RR＝1.07， 95%CI （1.01， 1.14）， P＝ 0.04]， the incidence of serious AEs [RR＝1.57， 95%CI （1.31， 1.87）， P＝0.03]， and the incidence of treatment discontinuation due to AEs [RR＝1.45， 95%CI （1.19， 1.76）， P＝0.01] were significantly higher in the experimental group than control group. There were no statistically significant difference in pCR in patients with negative PD-1/PD-L1[RR＝ E-mail：biejun23@126.com 1.26， 95%CI （0.98， 1.62）， P＝0.08] and pCR in patients with negative lymph nodes [RR＝1.14， 95%CI （0.97， 1.33）， P＝0.17] between the two groups. CONCLUSIONS Immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy demonstrates significant efficacy in early-stage TNBC patients， with more pronounced benefits observed in those who are PD-1/PD-L1 positive and lymph node- positive. However， the incidence of AEs is relatively high.

Objective: To understand the association between beverage and snack intake and insufficient serum 25 hydroxyvitamin D [25(OH)D] among primary and secondary school students, so as to provide a scientific basis for targeted intervention measures. Methods: From October to December 2021, a stratified random sampling method was used to select 2 477 primary and secondary school students aged 8 to 15 years old from 9 counties in Yunnan Province implemented the Nutrition Improvement Plan for Rural Compulsory Education Students. The intake of beverages and snacks was investigated using the Rural Student Nutrition Monitoring Questionnaire from Chinese Center for Disease Control and Prevention. The snack intake intensity was calculated and classified into no intake, extremely low, low, medium, and high intensity. Serum 25(OH)D levels were measured in the laboratory, and levels <20 ng/mL were defined as insufficient. Chi square tests, LASSO regression, random forest and binary Logistic regression were used to analyze the association between 20 types of beverages and snacks and serum 25(OH)D insufficiency. Results: Insufficient serum 25(OH)D was detected in 564 boys (45.9%) and 855 girls (68.5%), with a total of 1 419 cases (57.3%). Binary Logistic regression results showed that extremely low intake intensity of carbonated beverages ( OR =1.51), plant protein beverages ( OR =1.61), and milk tea beverages ( OR =1.39) increased the risk of insufficient serum 25(OH)D, while protective factors were fruits and vegetables ( OR =0.77) and pure milk and yogurt ( OR =0.74) (all P <0.05). Subgroup analysis showed that extremely low intake intensity of carbonated beverages, milk containing beverages, tea beverages, fruit and vegetable juices, and plant protein beverages increased the risk of insufficient serum 25(OH)D in girls ( OR =2.22, 1.72, 1.67, 1.74, 1.92), and high intake intensity increased the risk of insufficient serum 25(OH)D in boys ( OR =1.73, 1.48, 1.52, 1.49, 1.97) (all P <0.05). Extremely low intake intensity of carbonated beverages, plant protein beverages, and milk tea beverages in junior high school students ( OR =1.92, 2.54, 1.68) and low intake intensity in primary school students ( OR =1.40, 1.33, 1.45) increased the risk of insufficient serum 25(OH)D (all P <0.05). Conclusions Frequent intake of beverages and highly processed snacks increases the risk of insufficient serum 25(OH)D in primary and secondary school students, while natural foods such as fruits, vegetables, pure milk and yogurt can reduce the risk. Girls and junior high school students are more susceptible to these effects.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective:To investigate the current status of multidrug-resistant bacteria (MDRO) wound infections in patients with autoimmune bullous diseases (AIBDs), and to analyze their risk factors.Methods:A retrospective study was conducted, and inpatients with AIBDs accompanied by wound infections were collected from Hospital of Dermatology, Chinese Academy of Medical Sciences from January 2020 to December 2022. A descriptive analysis was carried out to analyze the basic characteristics of these patients and pathogenic characteristics of MDRO. Univariate and binary logistic regression models were used to analyze independent risk factors for MDRO infections in patients with AIBDs. Differences between the MDRO infection group and common bacterial infection group were analyzed by using t test, Mann-Whitney U test and chi-square test. Results:Totally, 271 patients with AIBDs accompanied by wound infections were included, including 159 males (58.7%) and 112 females (41.3%), and 142 patients (52.4%) were aged over 60 years. Most patients with AIBDs were diagnosed with pemphigus vulgaris (131 cases, 48.3%), or bullous pemphigoid (99 cases, 36.5%). Bacterial culture was positive in all the patients, and 74 (27.3%) were infected with MDRO; a total of 108 strains of MDRO were detected, with relatively high detection rates of Staphylococcus (82 strains, 75.9%) and Enterobacter (15 strains, 13.9%). Significant differences were observed between the MDRO infection group and the common bacterial infection group in the duration of hospitalization, involved body surface area, proportions of patients self-modificating drug dosage, proportions of patients topically using antibiotic ointments, proportions of patients using immunosuppressants, duration of glucocorticoid use, maximum dose of glucocorticoids and the first albumin level at admission (all P < 0.05), while there were no significant differences in the gender, age, proportions of patients at first hospitalization, types of AIBDs, duration of education, body mass index, disease duration, proportions of smoking patients, proportions of drinking patients, proportions of patients with comorbid chronic diseases, surgical history, prevalence of hypoalbuminemia, prevalence of mucosal involvement, proportions of patients receiving topical glucocorticoids, proportions of patients using biological agents, duration of antibiotic use, and the first total protein level at admission between the two groups (all P > 0.05). Logistic regression analysis showed that the use of topical antibiotic ointments, use of immunosuppressants, maximum dose of glucocorticoids, and self-modification of drug dosage were independent risk factors for MDRO infections (all P < 0.05) . Conclusions:The patients with AIBDs were prone to develop MDRO infections in wounds, and Staphylococcus infections were the most common. The use of topical antibiotic ointments, use of immunosuppressants, high dose of glucocorticoids, and self-modification of drug dosage may increase the risk of infections in patients with AIBDs.

With continuous advancements in medical technology, the tools and techniques for intravenous therapy and infusion are also evolving and innovating. This paper summarizes and analyzes the current application status of intravenous therapy infusion tools and techniques, thus providing deep reflections and suggestions to serve as a beneficial reference and guide for the development of these tools and techniques in China.

Objective To explore the oral mucosal manifestations of Sweet's syndrome and provide a reference for its early detection and correct diagnosis.Methods The oral mucosal manifestations of a 60-year-old female patient with Sweet's syndrome are described in detail,followed by a discussion of the related literature.Results The patient had skin erythema of both lower extremities,which was accompanied by oral mucosal ulceration and pain for 3 days.The patient presented with mild cutaneous lesions and diffuse large-scale erosion in the oral mucosa with obvious pain.During the onset of the disease,the patient was accompanied by fever with a temperature of 38.5℃.After visiting the Department of Stomatology,laboratory tests showed an increase in C-reactive protein(35.2 mg/L)and an accelerated erythrocyte sedimentation rate(77.00 mm/h).Scattered red plaques and mild tenderness were observed in the knees and lower limbs.Histopathological examination of the skin lesions revealed scattered infiltration of immature neutrophils across the entire dermis.The patient responded well to glucocorticoid therapy.According to the clinical signs and labo-ratory examination,combined with the lesion histopathological results,a diagnosis of Sweet's syndrome was given.The patient was administered 1 mL compound Betamethasone injection only once intramuscularly.In the meantime,the pa-tient was asked to gargle with compound chlorhexidine solution and topically apply recombinant bovine basic fibroblast growth factor solution to the damaged mucosa three times a day for 1 week.After 4 days of medication,the patient's body temperature had returned to normal and the oral lesions were significantly reduced.After 2 weeks,the erythema in the leg and knee had almost all subsided,and the oral mucosal lesions had disappeared.The patient was followed up 6 months after treatment,with no recurrence of skin lesions.After 2 years of follow-up,the disease was stable with no re-currence.A review of the relevant literature shows that Sweet's syndrome is a rare inflammatory reactive dermatosis with unknown etiology,which can be divided into three clinical types:specific,tumor-related,and drug-induced.The male/female prevalence ratio is 1:4.The salient clinical manifestations are abrupt onset of painful erythematous plaques or nodules most commonly involving the extremities,often accompanied by pyrexia,elevated neutrophil count,elevation of the erythrocyte sedimentation rate,and positive C-reactive protein.The use of glucocorticoids is the most common treatment for this disease,and most patients see a rapid improvement in skin lesions;however,some may experience infection or recurrence after withdrawal.Some patients with Sweet's syndrome are accompanied by oral lesions,but cases of oral mucosal damage have been rarely reported,and this condition is easily misdiagnosed.Conclusion Oral mucosal lesions may be extraterritorial manifestations of Sweet's syndrome,and the patient's systemic condition should be comprehensively considered.Skin biopsy should be completed as soon as possible to make a clear diagnosis,so as not to delay the disease.J Prev Treat Stomatol Dis,2024,32(8):620-624.

Objective To observe the value of the scoring model of MRI features for predicting proliferative hepatocellular carcinoma(HCC).Methods Data of 241 patients with pathologically confirmed HCC,including 90 cases of proliferative HCC and 151 cases of non-proliferative HCC were analyzed retrospectively.Univariate and multivariate logistic regression were used to compare the clinical and MRI findings evaluated according to liver imaging reporting and data system version 2018 between groups.The independent predictive factors of proliferative HCC were screened,and scores were assigned according to the weight,then a scoring model was constructed.Receiver operating characteristic(ROC)curve was drawn,and the area under the curves(AUC)were calculated to assess the predictive efficacy of this model.The patients were divided into high and low proliferation risk subgroups based on the optimal score thresholds.The recurrence free survival(RFS)rates and early RFS rates were compared between groups and subgroups.Results MRI showed tumor corona enhancement,arterial phase annular hyper-enhancement,intratumoral vessels,much focus parenchymal low enhancement and irregular tumor margins were all independent predictive factors for proliferative HCC(OR=3.287,2.362,4.542,2.997,2.379,all P＜0.05),which were then were scored with 7,5,9,7 and 5,respectively,with a total score of 0-33.AUC of the obtained scoring model for predicting proliferative HCC was 0.818.Taken 9 points as the optimal score thresholds,97 cases were assigned into high proliferation subgroup and 144 into low proliferation risk subgroups).Significant differences of RFS rates and early RFS rates were found between groups and subgroups(all P＜0.05).Conclusion MRI features scoring model could effectively predict proliferative HCC.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.