Objective: To investigate the distribution of pupil diameter and its association with myopia in school age children, providing ideas into the mechanisms of the role of pupil diameter in the onset and development of myopia. Methods: Adopting a combination of stratified cluster random sampling and convenience sampling method, 3 839 children from six schools in Shandong Province were included in September 2021. Pupil diameters distribution was analyzed by age, sex, and myopic status. Pearson correlation analysis was used to assess the relationship between pupil diameter and cycloplegic spherical equivalent (SE), as well as axial length (AL) and other variables. Propensity score matching (PSM) was applied to match myopic and non myopic children at a 1∶1 ratio based on age and sex. A generalized linear model (GLM) was constructed with pupil diameter as the dependent variable to identify independent factors influencing pupil size and its association with myopia. Results: The mean pupil diameter of school age children was (5.77±0.80)mm. Pupil diameter exhibited a significant increasing trend with age ( F =49.34， P trend ＜ 0.01). Myopic children had a significantly larger mean pupil diameter [(6.10±0.73)mm] compared to non myopic children [(5.62±0.79)mm] with a statistically significant difference( t=18.10, P <0.01). Multivariable GLM analysis, adjusted for age, amplitude of accommodation, and uncorrected visual acuity, revealed a negative correlation between pupil diameter and cycloplegic SE (before PSM: β =-0.089, after PSM: β =-0.063, both P ＜0.01). Conclusions Myopic school age children exhibite larger pupil diameters than their non myopic counterparts. Pupil diameter may serve as a potential indicator for monitoring myopia development in school age children.

Objective:To understand the composition of respiratory virus spectrum in hospitalized children with acute respiratory infections in Guilin City from 2021 to 2022, and to explore the epidemic characteristics of different respiratory viruses.Methods:Information of a total of 638 hospitalized children with acute respiratory infections (ARI) syndrome under the age of 14 years in Guilin city, Guangxi from September 2021 to October 2022 was collected as research data. The collected pharyngeal swabs from pediatric patients were subjected to real-time fluorescence reverse transcription polymerase chain reaction for nucleic acid testing, screening for 15 common respiratory viruses, and analyzing the virus spectrum characteristics of hospitalized pediatric patients with acute respiratory infections.Results:Among the 638 specimens, 365 were tested positive for at least one virus, with a positive rate of 57.21% (365/638). The detection rate for two or more viruses was 12.85% (82/638). There were 12 types of viruses detected, and the difference in virus detection rates among different seasons was statistically significant (P<0.002). The virus positive detection rate of samples from different age groups was the highest in the 0-2-year old group (40.66%), followed by the 3-5-year old group (34.80%) and the 6-year and older group (24.54%).Conclusions:During the period from September 2021 to October 2022, all 12 respiratory viruses were prevalent in Guilin area, with obvious summer peak as characteristics. It is suggested that corresponding prevention and control measures should be focused on pathogens that may cause acute respiratory infections in children during the local summer to prevent and control the spread and prevalence of respiratory infections.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

{L-End}Objective To analyze the characteristics of hearing loss and the influencing factors of high-frequency hearing loss (HFHL) among noise-exposed workers in an urban rail transit enterprise over five consecutive years. {L-End}Methods A total of 1 268 noise-exposed workers, who exposed to the average noise intensity of <85.0 dB(A), in an urban rail transit enterprise was selected as the research subjects using a judgment sampling method. The pure-tone audiometry results from 2019 to 2023 were collected to analyze the result of hearing loss. The influencing factors of HFHL (average hearing threshold ≥40.0 dB at high frequencies in both ears) were analyzed using the generalized estimating equations (GEE). {L-End}Results The detection rates of threshold elevations at frequencies of 0.5-6.0 kHz increased with increasing frequency from 2019 to 2023 (all P<0.01), with the highest detection rate at 6.0 kHz. The detection rate of speech frequency hearing loss (hearing threshold weighted value≥26.0 dB in the better ear) was 0.1%, 0.0%, 0.4%, 0.2%, and 0.2%, respectively. The detection rate of HFHL from 2019 to 2023 was 2.4%, 2.8%, 2.8%, 2.1%, and 2.8%, respectively. The GEE analysis results showed that the risk of HFHL of the workers in 2022 and 2023 was lower than that in 2019 (all P<0.01), with the odds ratios and 95% confidence intervals ［OR (95%CI)］ of 0.57 (0.41-0.81) and 0.65 (0.48-0.87), respectively. The risk of HFHL was higher among vehicle maintenance worker than train drivers (P<0.05), with OR (95%CI) of 2.37 (1.18-4.77). The risk of HFHL increased with age and length of service among the workers (all P<0.05), with the OR (95%CI) of 2.05 (1.22-3.46) and 1.69 (1.12-2.54), respectively. No interaction was found between type of job and age, type of job and length of service, or age and length of service in the risk of HFHL among the research subjects(all P<0.05). {L-End}Conclusion Noise exposure below the national occupational exposure limits can lead to hearing loss in noise-exposed workers of urban rail transit enterprises, possibly affecting the hearing threshold at 6.0 kHz first. The influencing factors for HFHL in workers of rail transit are age, length of service, and type of job. There is a dose-effect relationship with age and length of service.

Objective:To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage (APD) in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed. Patients were divided into APD group ( n=56) and NO-APD group ( n=51) according to whether they underwent APD or not within 3 days after admission. The APD group was then divided into abdominal compartment syndrome (ACS) subgroup ( n=29) and NO-ACS subgroup ( n=27) according to whether ACS had occurred or not at the time of puncture. Patients' general data, the duration of systemic inflammatory response (SIRS), length of ICU stay, the trends of intra-abdominal pressure and inflammatory indicators (white blood cell count and the content of C-reactive protein) within 1-3 days after admission, incidence of infection complication, step-up therapy, discharge or death were recorded. Results:The intra-abdominal pressure were 18.6±5.6mmHg , 13.7±4.2mmHg (1 mmHg=0.133 kpa) in APD group and NO-APD group, respectively. The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group, and the difference was statistically significant ( P=0.000). Compared with NO-APD group, the duration of SIRS was significantly shortened in APD group [3(2, 4) days vs 4(3, 6) days, P=0.029]. On day 1, 2 and 3 after admission, the intra-abdominal pressure was 18.6±5.6 mmHg, 16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group, and was 13.7±4.2 mmHg, 12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group, respectively. The intra-abdominal pressure of the APD group dropped faster than the NO-APD group ( P=0.004). The white blood cell count was (14.8±4.8), (10.5±4.5) and (9.0±3.8)×10 9/L in APD group, and was (14.2±5.4), (12.3±7.3), (11.7±5.3)×10 9/L in NO-APD group, respectively. Compared with the NO-APD group, the decrease rate of white blood cell count was faster in APD group ( P=0.006). The C-reactive protein content was (153.6±47.1), (150.4±10.5) and (108.8±49.4)mg/L in APD group, and were (174.8±31.1), (191.6±29.4) and (186.8±45.5)mg/L in NO-APD group . The content of C-reactive protein in APD group decreased significantly, while that in NO-APD group did not decrease. There was a significant difference between the two groups ( P=0.009). In the subgroup comparisons, the duration of SIRS in the ACS subgroup was significant longer than that in the NO-ACS subgroup [4(3, 5) days vs 2(1, 3)days, P=0.000]. Compared between the two groups and two subgroups respectively, there were no statistically significant differences on length of ICU stay, infection complication rate, advanced treatment rate and mortality. Conclusions:For SAP patients with abdominal fluid, APD in the early stage could shorten the duration of SIRS, decrease intra-abdominal pressure rapidly, improve inflammatory indicators, but could not improve the clinical outcome.

Objective:To investigate the protective mechanism of topoisomerase I inhibitor on pancreatic acinar cells and lung during acute pancreatitis (AP) in mice.Methods:Eighteen Balb/C male mice were randomly divided into three groups using random number method: control group, AP group and CPT+ AP group. AP model was established by intraperitoneal injection of caerulein and lipopolysaccharide. CPT+ AP group received intraperitoneal injection of camptothecin (CPT, 50 mg/kg) before AP induction. Mice in control group were intraperitoneal injected with an equal volume of normal saline. The pathological examinations of pancreas and lung tissue were analyzed. The serum levels of amylase and lipase were detected by enzyme linked immunosorbent assay (ELISA) and the mRNA expression of IL-1 and IL-6 were analyzed by reverse transcription-polymerase chain reaction (RT-PCR); the infiltration of CD 45+ cells in pancreas and lung tissue as well as the expression of phosphorylated mixed lineage kinase domain-like protein(MLKL) in pancreas were detected by immunohistochemistry; the apoptosis index of pancreatic cells was analyzed by TUNEL assay. Results:The pathological scores of pancreas and lung tissue, serum levels of amylase and lipase in CPT+ AP group were [(2.30±0.31), (2.29±0.34), (1742.33±183.51)U/L and (46.90±2.17)U/L], which were significantly lower than those in AP group [(5.06±0.88), (3.40±0.09), (2385.33±383.10)U/L and (69.13±9.76)U/L]; the mRNA expression of IL-1 and IL-6 in pancreatic tissue were 95.79±48.11, 255.50±213.32, which were also remarkably lower than those in AP group (212.35±80.61, 1006.80±509.06); the infiltration of CD 45+ inflammatory cells in pancreas and lung were (14.25±5.32, 29.20±4.44)/high power field, which were notably lower than those in AP group (59.83±13.67, 58.25±5.91)/high power field; the apoptosis index of pancreatic cells was significantly higher than that in AP group [(3.64±1.16)% vs (1.92±0.29)%]; the histochemistry score of phosphorylated MLKL protein in pancreatic tissue was significantly lower than that in AP group (1.75±0.20 vs 4.53±1.28), and the differences were statistically significant (all P value <0.05). Conclusions:Topoisomerase I inhibitor could induce the apoptosis of pancreatic acinar cells and inhibit the death mode of necrotic pancreatic acinar cells during AP remodeling, thus reducing pancreatic local injury and AP-associated lung injury.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

OBJECTIVE: To evaluate the exposure status of hand-transmitted vibration(HTV)in golf ball head grinding workers.METHODS: The golf ball head grinding positions in a sports equipment factory were selected as the research subjects by the judgement sampling method.The HTV exposure level of the workers in 66 grinding positions was measured,the key control points for HTV hazards were identified,and the damage of HTV was classified.RESULTS: The median(M)of 4 hours energy equivalent frequency-weighted acceleration to vibration[a_(hw(4))]of grinding positions in this sports equipment factory was 4.21 m/s~2,and the a_(hw(4)) over standard rate was 50.0%(33/66).The a_(hw(4)) of rough grinding positions was higher than that of fine grinding positions(M:5.50 v.s 3.94 m/s~2,P<0.05).In both rough grinding positions and fine grinding positions,the a_(hw(4)) of different ball head grinding types from high to low were hollow titanium alloy ball heads, hollow stainless steel ball heads,and solid stainless steel ball heads(rough grinding positions M:7.41 vs4.43 vs 3.11 m/s~2,P<0.01; fine grinding p ositions M:5.24 vs 4.21 vs 2.93 m/s~2,P<0.01).For the hollow titanium alloy ball head grinding positions,the a_(hw(4)) of rough grinding was higher than that of fine grinding(M:7.47 vs 5.24 m/s~2,P<0.01).Rough grinding positions,especially hollow stainless steel ball heads and hollow titanium alloy ball head grinding positions were key control points for HTV hazards.In the 66 grinding positions,the HTV hazards were classified as grade 0,Ⅰ,Ⅱ,and Ⅲ in the grinding positions accounted for 3.0%,47.0%,40.9%,and 9.1%,respectively,and those with grade Ⅱ and above were 50.0%(33/66). CONCLUSION: The exposure level of HTV in golf ball head grinding workers is high,with a trend of exceeding the standard.The golf ball head grinding workers have a high occupational health risk.

Objective: To analyze the epidemic features of male HIV-infected and AIDS patients by sexual transmission in Shandong Province. Methods: Data on HIV-infected people and AIDS patients (HIV/AIDS) were derived from HIV/AIDS Comprehensive Response Information Management System. To analysis the epidemiological data of male HIV/AIDS by sexual transmission reported in Shandong Province from 1997 to 2016. Results: A total of 8 584 HIV/AIDS were reported by heterosexual transmission or homosexual transmission from 2007 to 2016. 2 421 cases were reported by heterosexual transmission and 6 163 cases were reported by homosexual transmission. Among cases infected by heterosexual transmission. The average age of cases infected by heterosexual transmission was (38.13±12.39) and (31.62±10.22) among cases who infected by homosexual transmission (t=24.95, P<0.001). 84 cases were reported by homosexual transmission and 138 cases by heterosexual transmission from 2007 to 2008, and 6 079 cases were reported by homosexual transmission and 2 283 cases by heterosexual transmission from 2009 to 2016. A total of 770 cases were dead after reported. Among the dead cases, 337 cases were infected by homosexual transmission and 433 cases by heterosexual transmission (χ²=328.21, P<0.001). 61.4% of the dead cases by heterosexual transmission were no longer than 6 months after reported and 54.3% in homosexual transmission (χ²=3.96, P=0.047). Conclusion Homosexual transmission has been the main transmission of HIV/AIDS in Shandong Province. Epidemiological features and social demographic characteristics of each sexual transmission were different. As part of HIV cases developed to death in 6 months.

Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach.Methods From March 2006 to September 2009,data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed.There were 14 males and 7 females.The mean age of the patients was 31.6 years (range,18-52 years).Injury was caused by walk falling in 10 cases,falling from standing-height in 3 cases and sports events in 8 cases;7 patients were left side and 14 patients were right side,including 16 prominent sides and 5 non-prominent sides.There were 3 type Ⅰa,3 type Ⅱa,8 type Ⅱb,4 type Ⅱc,3 type Ⅲa coronoid process fractures according to the O'Driscoll's classification.Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows.Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve,and then lateral collateral ligaments were repaired if instability still existed.Results The average operation time was 72 min,and the follow-up time was 52-74 months.Only 1 case of type Ⅰa fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace.At the latest follow-up,in suture anchor fixation group (3 cases),the average VAS was 1.8±0.5,Broberg-Morrey score 90.2±6.6,extension deficiency 11.2°±3.6°,flexion 133.4°±8.8°,and the excellent-good-rate was 66.7％ (2 cases excellent and 1 fair).In the screw-fixation group (10 cases),the average VAS was 1.6±0.8,Broberg-Morrey score 89.2±6.6,extension deficiency 15.2°±4.6°,flexion 130.8°±10.8°,and the excellent-good-rate was 90％ (6 cases excellent,3 good,and 1 fair).In the mini plate fixation group (8 cases),the average VAS score was 1.6±0.7,Broberg-Morrey score 88.6±6.7,extension deficiency 11.8°±5.6°,flexion 134.2°±8.6°,and the excellent-good-rate was 87.5％ (4 cases excellent,3 good,and 1 fair).In the lateral ligament repaired group (14 cases),the average VAS was 1.3±0.9,Broberg-Morrey score 91.5±6.3,extension deficiency 10.2°±3.4°,flexion 135.2°±4.2°,and the excellent-good-rate was 100％ (8 cases excellent,6 good).In the lateral ligament non-repaired group (7 cases),the average VAS was 2.2± 1.6,Broberg-Morrey score 80.2± 13.8,extension deficiency 13.6°±4.4°,flexion 126.6°±4.0°,and the excellent-good-rate was 71.4％ (3 cases excellent,2 good,1 fair).There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years' follow-up,with the incidence rate 23.8％ (5/21),and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8％ (1/21).Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe.Lateral collateral ligaments should be repaired if the elbow is unstable.