AIM: To investigate the effect of residual astigmatism on visual quality after phacoemulsification combined with regional refractive intraocular lens(IOL)implantation in patients with age-related cataract, and to evaluate the astigmatism inclusivity of regional refractive IOL.METHODS: Retrospective cohort study. The clinical data of 62 cases(73 eyes)of age-related cataract patients who underwent phacoemulsification combined with regional refractive IOL(Lentis Comfort LS-313 MF15)implantation from July 2020 to March 2022 at the ophthalmology department of our hospital were collected. They were grouped according to residual astigmatism at 6 mo postoperatively, taking 35 cases(40 eyes)with residual astigmatism of 0.75 D to 1.50 D as the experimental group, and 27 cases(33 eyes)with residual astigmatism ≤0.75 D as the control group. Visual acuity, defocus curves, objective visual acuity [wavefront aberrations, Strehl ratio(SR), modulation transfer functions(MTF)], subjective visual acuity(national eye institute visual function questionnaire-25), patients' satisfaction, and spectacle independence were compared between the two groups at 6 mo postoperatively.RESULTS:There was a difference in the preoperative astigmatism and the number of postoperative 6 mo residual astigmatism between the two groups(P<0.01). At 6 mo postoperatively, there was no difference in uncorrected distance, intermediate, and near visual acuity, objective visual quality, subjective visual quality, satisfaction, and spectacle independence between the two groups(P>0.05). The defocus curves showed that there was no difference in visual acuity between the two groups at all points in the +2.00 to -4.00 D defocus range of the additional spherical equivalent(P>0.05).CONCLUSION:Lentis Comfort LS-313 MF15 IOL was able to accommodate regular astigmatism of 1.50 D.

Objective To investigate the effect of residual corneal astigmatism on visual acuity after regional refrac-tive intraocular lens(IOL)implantation.Methods A retrospective cohort study was conducted.The medical records and follow-up data of 73 eyes of 57 cataract patients who underwent ultrasound emulsification cataract extraction combined with LENTIS Comfort LS-313 MF15 IOL implantation in the Ophthalmology Department of the Hebei General Hospital from June 2020 to March 2022 were collected.These patients were grouped according to postoperative residual corneal astigmatism:32 patients(40 eyes)with a residual corneal astigmatism of 0.75(exclusive)-1.50 D were taken as the experimental group,and 25 patients(33 eyes)with a residual corneal astigmatism ≤0.75 D were taken as the control group.The uncor-rected distance visual acuity(5 m),uncorrected intermediate visual acuity(80 cm),uncorrected near visual acuity(40 cm),out-of-focus curve,objective visual quality,subjective visual quality,satisfaction degree and lens removal rate of pa-tients in the two groups were recorded 6 months postoperatively.Results The postoperative uncorrected distance visual acuity(logMAR)was 0.10(0.00,0.22),the uncorrected intermediate visual acuity(logMAR)was 0.00(0.00,0.10),and the uncorrected near visual acuity(logMAR)was 0.20(0.10,0.30)and 0.20(0.10,0.20)in the experimental and control groups,with no statistically significant differences(all P＞0.05).The postoperative out-of-focus curves showed that the distance visual acuity of patients with additional spherical equivalent refraction ranged from+2.00 D to-4.00 D in the two groups had no statistically significant difference(all P＞0.05).There were statistically significant differences in to-tal aberration,coma aberration,modulation transfer function and Strehl ratio in the objective visual quality of patients after surgery(all P＜0.05),and there was no statistically significant difference in the total higher-order aberration,spherical ab-erration and cloverleaf aberration(all P＞0.05).There was no statistically significant difference in the subjective visual quality,satisfaction degree and lens removal rate in the two groups(all P＞0.05).Conclusion Residual corneal astig-matism of 0.75 D to 1.50 D after LENTIS Comfort LS-313 MF15 IOL implantation has no effect on higher-order aberration,spherical aberration,and cloverleaf aberration in subjective and objective visual quality,and has an impact on total aberra-tion,coma aberration,modulation transfer function and Strehl ratio in objective visual quality.

Objective:To observe the characteristics of early changes in choroidal thickness and choroidal microvascular morphology in the macula of patients with systemic lupus erythematosus (SLE) using swept-source optical coherence tomography angiography (OCTA).Methods:A cross-sectional study was conducted.Thirty-seven patients (37 eyes) who were diagnosed with SLE without obvious ocular symptoms in Hebei General Hospital from January 2022 to July 2022 were enrolled in this study as a SLE group.At the same time, 35 normal adults (35 eyes) matched with age and sex were included as a control group.Swept-source OCT was used to perform a 9 mm×9 mm radial scan of the macular region of subjects to obtain the average choroidal thickness of the macular central concave area, the paracentral concave area (1-3 mm), and the pericentral concave area (3-6 mm). OCTA was used to perform a 3 mm×3 mm scan of the macular region and images of retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) blood flow density, choroidal capillary plexus (CC) blood flow density, and microvascular blood flow in the macular region were obtained and binarized using ImageJ software (Phansalkar method) to calculate the choroidal capillary flow void area (FDa) and percentage of flow deficits (FD%). The study protocol followed the Declaration of Helsinki and was approved by the Ethics Committee of Hebei General Hospital (No.202310). Informed consent was obtained from all subjects.Results:The choroidal thickness of the subfoveal region in SLE group was (268.73±81.67)μm, which was significantly higher than (230.14±68.14) μm of control group ( t=2.170, P=0.033). The blood flow density of SCP, DCP and CC in the macular central zone area of SLE group were (16.58±3.90)%, (14.25±3.15)% and (51.80±4.27)%, respectively, which were significantly lower than (20.55±4.41)%, (16.57±3.74)% and (54.33±3.41)% of control group ( t=-4.043, -2.851, -2.763; all at P<0.05). The FDa and FD% in SLE group were 3.43(3.25, 3.56)mm 2 and 38.11%(36.13%, 39.52%), which were greater than 3.25(3.21, 3.32)mm 2 and 36.11%(35.64%, 36.84%) of control group, and the differences were statistically significant ( Z=-3.470, -3.476; both at P<0.05). Conclusions:OCTA can detect an increase in choroidal thickness and a decrease in blood flow density of CC in eyes with SLE without obvious ocular symptoms.

Objective:Assess the 10-year Immune persistence and the predictors after primary vaccination hepatitis B vaccine (HepB) among normal and high-responder infants.Methods:A total of 1 838 Infants of 7-12 months old located in Jinan, Weifang, Yantai and Weihai of Shandong Province who were induced normal or high antibody response (anti-HBs titer ≥ 100 mIU/ml) after primary vaccination (three dose with 0-1-6 procedure) with 5 μg recombinant HepB among newborns were included in the study, in 2009. 3 ml of venous blood samples were collected at baseline survey (T 0) and antibodies against hepatitis B surface antigen (anti-HBs), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected using chemiluminescence microparticle immunoassay (CMIA) method. A self-designed questionnaire was used to collect information including the infant′s age, sex, birth weight, premature birth, birth number, delivery location and mother′s HBV infection status. In 2014 (followed up for 5 years) and in 2019 (followed up for 10 years) (T 1), 2 ml of venous blood samples were collected. Anti HBS and anti HBC were detected by CMIA method. Those with anti HBS<10 mIU/ml were detected by CMIA method. Multivariate unconditional logistic and linear regression models were used to analyze the influencing factors of anti-HBs positive rate and geometric mean concentration (GMC) at T 1. Results:After 10 years follow-up, 73.94% of the subjects (1 359/1 835) finished the follow-up. 51.15% of the subjects, a total of 625 were boys. The positive rate of anti-HBs was 100% at T 0 and decreased to 53.44% (95% CI: 50.59%-56.26%) at T 1. The average annual decline rate of anti-HBs positive rate from T 0 to T 1 was 6.07%. The GMC of anti-HBs decreased from 607.89 (95% CI: 579.01-642.62) mIU/ml to 16.44 (95% CI: 15.06-18.00) mIU/ml. The average annual decline rate of anti-HBs GMC in 10-year follow-up was 30.30%. Multivariate logistic analysis showed that the positive rate of anti-HBs at T 1 was lower in those who did not vaccinate the first dose in time ( OR=0.25, 95% CI:0.07-0.71). Compared with those with GMC<1 000 mIU/ml at T 0, those with GMC ≥ 1 000 mIU/ml had a higher positive rate of anti-HBs at T 1 ( OR=2.29, 95% CI:1.76-2.97). Multivariate regression analysis showed that the GMC of anti-HBs at T 1 was lower in those who did not vaccinate the first dose in time (β=-0.50, 95% CI:-1.24-0.24). Compared with those with GMC<1 000 mIU/ml at T 0, those with GMC ≥ 1 000 mIU/ml had a higher GMC of anti-HBs at T 1 (β=0.81, 95% CI: 0.62-1.05). Conclusion:Anti-HBs GMC decreased in 10 years after primary vaccination of 5 μg recombinant hepatitis B vaccine among normal and high-responders. The anti-HBs persistence was mainly associated with whether the first dose was vaccinated in time and the level of anti-HBs at the end of primary vaccination.

Objective:Assess the 10-year Immune persistence and the predictors after primary vaccination hepatitis B vaccine (HepB) among normal and high-responder infants.Methods:A total of 1 838 Infants of 7-12 months old located in Jinan, Weifang, Yantai and Weihai of Shandong Province who were induced normal or high antibody response (anti-HBs titer ≥ 100 mIU/ml) after primary vaccination (three dose with 0-1-6 procedure) with 5 μg recombinant HepB among newborns were included in the study, in 2009. 3 ml of venous blood samples were collected at baseline survey (T 0) and antibodies against hepatitis B surface antigen (anti-HBs), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected using chemiluminescence microparticle immunoassay (CMIA) method. A self-designed questionnaire was used to collect information including the infant′s age, sex, birth weight, premature birth, birth number, delivery location and mother′s HBV infection status. In 2014 (followed up for 5 years) and in 2019 (followed up for 10 years) (T 1), 2 ml of venous blood samples were collected. Anti HBS and anti HBC were detected by CMIA method. Those with anti HBS<10 mIU/ml were detected by CMIA method. Multivariate unconditional logistic and linear regression models were used to analyze the influencing factors of anti-HBs positive rate and geometric mean concentration (GMC) at T 1. Results:After 10 years follow-up, 73.94% of the subjects (1 359/1 835) finished the follow-up. 51.15% of the subjects, a total of 625 were boys. The positive rate of anti-HBs was 100% at T 0 and decreased to 53.44% (95% CI: 50.59%-56.26%) at T 1. The average annual decline rate of anti-HBs positive rate from T 0 to T 1 was 6.07%. The GMC of anti-HBs decreased from 607.89 (95% CI: 579.01-642.62) mIU/ml to 16.44 (95% CI: 15.06-18.00) mIU/ml. The average annual decline rate of anti-HBs GMC in 10-year follow-up was 30.30%. Multivariate logistic analysis showed that the positive rate of anti-HBs at T 1 was lower in those who did not vaccinate the first dose in time ( OR=0.25, 95% CI:0.07-0.71). Compared with those with GMC<1 000 mIU/ml at T 0, those with GMC ≥ 1 000 mIU/ml had a higher positive rate of anti-HBs at T 1 ( OR=2.29, 95% CI:1.76-2.97). Multivariate regression analysis showed that the GMC of anti-HBs at T 1 was lower in those who did not vaccinate the first dose in time (β=-0.50, 95% CI:-1.24-0.24). Compared with those with GMC<1 000 mIU/ml at T 0, those with GMC ≥ 1 000 mIU/ml had a higher GMC of anti-HBs at T 1 (β=0.81, 95% CI: 0.62-1.05). Conclusion:Anti-HBs GMC decreased in 10 years after primary vaccination of 5 μg recombinant hepatitis B vaccine among normal and high-responders. The anti-HBs persistence was mainly associated with whether the first dose was vaccinated in time and the level of anti-HBs at the end of primary vaccination.

A patient with intermittent right lumbar pain for more than one month and aggravating for one week was reported. The right laparoscopic radical nephrectomy was performed, and fibrosarcoma of the right kidney was diagnosed. The patient refused further radiotherapy or chemotherapy and was discharged on the 11th after surgery. One year after operation, the patient underwent chest CT, and subdural tumor of right lobe of liver was detected. A surgery was performed in another hospital, and liver metastasis from right renal fibrosarcoma was diagnosed. He was alive four months after operation.

Viral hepatitis has been causing big threat to public health globally. The number of annual deaths caused by hepatitis surpassed the deaths caused by AIDS, tuberculosis, and malaria. World Health Organization (WHO) issued the global health sector strategy on viral hepatitis 2016-2020 (GHSS) to control its epidemic. It established the Strategies and Technical Advisory Committee on HIV, viral hepatitis, and sexually transmitted infections (STAC). This paper summarizes the GHSS goals and the keynote of the 2020 STAC meeting, analyzes the challenges and opportunities faced by China in eliminating viral hepatitis, and provides the comments on the papers on this issue, which could guide further actions.

Objective:To understand the characteristics of hepatitis B cases reported through the National Notifiable Disease Reported System (NNDRS) of China in 2019, analyze the quality of hepatitis B reporting.Methods:The survey forms and reporting cards of hepatitis B cases in 200 surveillance points in China in 2019 were collected from NNDRS, the completeness rate of the reporting card was calculated, and the reported hepatitis B cases were verified based on the diagnostic criteria (WS 299-2008). The clinical types of the cases after verification were compared with the reported ones, the consistency was evaluated with Kappa test. The reasons for the inconsistent clinical types of the cases were analyzed.Results:In 2019, a total of 64 686 hepatitis B cases were reported through NNDRS. Acute, chronic and unclassified hepatitis B cases accounted for 5.8%, 92.4% and 1.8%, respectively. The average age of reported cases was 47 (47±15) years, and males accounted for 64.4%. The average level of alanine aminotransferase was 214.2 (214.2±1 253.4) U/L. The reported cases mainly worked in agriculture, forestry, animal husbandry, fishery, and water conservancy (50.6%, 32 722). The proportions of cases reported from the eastern, western and central regions were 42.5% (27 501),22.1% (14 315) and 35.4% (22 870), respectively. The consistent rate of the clinical types between the reported cases and the verified cases was 58.8%, with a Kappa value of 0.15. For the 39 271 cases confirmed as acute and chronic hepatitis B cases in the reporting cards, the consistent rate of the clinical types between the reported cases and the verified cases was 96.9%, with a Kappa value of 0.73. In 94.5% (24 267/25 681) of the cases with inconsistent clinical types, the reporting card information were incomplete.Conclusion:The diagnosis of hepatitis B has been improved in the hepatitis B surveillance in China, but it is necessary to improve the completeness of the reporting cards of hepatitis B cases to NNDRS.

Objective:To make a cost-benefit analysis of the hepatitis B vaccination (HepB) to prevent mother-to-child transmission (PMTCT) strategies in China, 1992-2019.Methods:We built a decision analytic-Markov model to estimate the birth cohorts of 1992-2019. The parameters in our model were referred from literature, published yearbooks, and data from Chinese Center for Disease Control and Prevention. We conducted a univariate sensitivity analysis to test the robustness of the model.Results:For the 28 birth cohorts, the Chinese government has invested 37.43 billion RMB Yuan in direct costs and 47.61 billion RMB Yuan in societal costs on HepB vaccination and HBV prevention of mother to child transmission (PMTCT). And we estimated that about 50 million chronic HBV infections and 12.5 million premature deaths due to HBV-related diseases would be averted. China would save 2.89 trillion RMB Yuan and 6.92 trillion RMB Yuan for the direct and societal medical burden on HBV-related conditions. The direct and societal net benefit was 2.85 trillion RMB yuan 6.87 trillion RMB yuan, respectively. The direct and societal benefit-cost ratios (BCRs) were 77.21 and 145.29, respectively.Conclusion:The strategies of HepB vaccination for HBV PMTCT prevention were cost-effective in China during 1992-2019.

Objective:To evaluate the persistence of HBsAg-specific antibodies eight years after revaccination with hepatitis B vaccine (HepB) among adults who were non-responsive to primary immunization.Methods:From August to September 2009, rural communities in Zhangqiu district of Ji'nan city were selected as the study site. The subject's inclusion criteria were 18 to 49 years old, local resident population, without HBV infection history and HepB vaccination history, and good health status. Antibodies against hepatitis B surface antigen (anti-HBs) were detected in adults following the standard primary vaccination. Those who were non-responders (anti-HBs titer <10 mIU/ml) were revaccinated with three doses of HepB and included in the study. Blood samples were collected from all of them at one month (T 1), two years, four years, and eight years after revaccination. The three indexes of anti-HBs, hepatitis B surface antigen (HBsAg), together with antibody against hepatitis B core antigen (anti-HBc), were measured by chemiluminescence microparticle immunoassay (CMIA). Results:The proportion of subjects with anti-HBs titers ≥10 mIU/ml was 85.12% (549/645) at T 1, 60.60% (283/467) at two years, 55.90% (199/356) at four years and 55.09% (222/403) at eight years after revaccination. The first two years' annual decline rates, three to four years and five to eight years, were 15.62%, 3.96%, and 0.36%. The GMC of anti-HBs was 153.92 mIU/ml at T 1, 21.43 mIU/ml at two years, 15.02 mIU/ml at four years, and 13.68 mIU/ml at eight years. In the first two years, three to four years and five to eight years, the annual decline rate of GMC was 62.69%,16.28%, and 2.31%, respectively. Multivariable analysis showed that the titer of anti-HBs at T 1 was independently associated with the persistence of anti-HBs at eight years after revaccination. Compared with anti-HBs titer <100 mIU/ml , those whose anti-HBs titers were 100-mIU/ml and ≥1 000 mIU/ml at T 1 had a higher positive rate of anti-HBs ( OR=14.13, P<0.001; OR= 62.91, P<0.001) and a higher probability of anti-HBs titer ( β=1.88, P<0.001; β=3.24, P<0.001) at 8 years after revaccination. Nobody was found seroconversion of HBsAg, and the anti-HBc positive rate was 14.14% (57/403). Conclusions:Following revaccination with three doses of HepB in adults who were non-responsive to primary immunization, anti-HBs titers declined rapidly within the first four years. They then maintained a stable level after the fifth year. More than half still kept anti-HBs protective titer at eight years after revaccination. The immunity persistence was associated with anti-HBs titer at one month after revaccination.