AIM: To investigate the diagnostic value of the difference of binocular biological parameters of the anterior segment in early keratoconus.METHODS: Retrospective case-control study. A total of 183 patients(366 eyes)who visited our hospital from March 2022 to November 2023 were included, including 107 cases(214 eyes)in the control group(patients with simple refractive error), 40 cases(80 eyes)in the subclinical keratoconus group, and 36 cases(72 eyes)in the clinical keratoconus group. All of the patients were examined by the Pentacam anterior segment analyzer to determine the inferior-superior 3 mm of the posterior corneal surface(I-S), corneal posterior elevation of the thinnest point(P.E.), maximum posterior elevation of the best fit sphere(MPE from BFS), the maximum posterior elevation of the best fit toric ellipsoid(MPE from BFTE), posterior aspherical asymmetry index(AAI), central corneal thickness(CCT), thinnest corneal thickness(TCT), pachymetric progression index average(PPIavg), Ambrósio relational thickness maximum(ARTmax), Belin/ Ambrósio enhanced ectasia display(BAD-D), and the binocular difference of each test was calculated separately for each patient. The control group was further divided according to corneal diameter: 21 cases(42 eyes)with corneal diameter <11.2 mm in group A, 54 cases(108 eyes)with 11.2 mm≤ corneal diameter ≤11.8 mm in group B, and 32 cases(64 eyes)with corneal diameter >11.8 mm in group C.RESULTS: There was significant differences in the binocular I-S, P.E., MPE from BFS, MPE from BFTE, AAI, CCT, TCT, PPIavg, ARTmax and BAD-D between the clinical keratoconus group and the control group(P<0.05). The difference of binocular I-S, P.E., MPE from BFS, MPE from BFTE, AAI, CCT, TCT, PPIavg, and BAD-D were of high diagnostic value(AUC≥0.900), with the best diagnostic ability for P.E. and BAD-D, and an AUC as high as 0.999 and 0.995, respectively. The difference of binocular P.E. and ARTmax between the subclinical keratoconus group and the control group were statistically significant(P<0.05). The difference of binocular I-S, P.E. and BAD-D had high diagnostic value for subclinical keratoconus(AUC≥0.900). In the control group A, B and C, there were no significant difference in binocular I-S, CCT, TCT, MPE from BFS, MPE from BFTE, AAI, PPIavg and ARTmax(all P>0.05), and none of them had correlation with corneal diameter(P>0.05); however, there were statistical significant differences in binocular P.E. and BAD-D in the control group A, B and C(P=0.007, 0.003), while the P.E. differences had no correlation with corneal diameter(P=0.270), and binocular BAD-D differences were negatively correlated with corneal diameter(r=-0.230, P=0.017).CONCLUSION: Pentacam anterior segment analyzer can accurately measure a variety of corneal biological parameters. Difference of binocular corneal I-S, P.E. and BAD-D are sensitive indexes for the early diagnosis of keratoconus. Among them, difference of binocular I-S and P.E. are less affected by corneal diameter, thus being significant for the early diagnosis of keratoconus with different cornea diameters.

Objective:To determine incidence of seasonal influenza virus infection in the community and to analyze the factors influencing seasonal influenza virus infection.Methods:This study recruited residents aged 6-59 years to build a cohort in 15 villages/streets in Macheng city in November 2019. Meanwhile, a cross-sectional baseline survey was conducted immediately to collect sera, information on demographics and child protection knowledge, behaviors, as well as attitudes using a questionnaire from the participants enrolled in the cohort (i.e., before the influenza epidemic season). In July 2020, a cross-sectional follow-up survey was conducted to collect sera once again (i.e., after the influenza season). Paired sera from the two cross-sectional surveys were tested for influenza virus-specific antibodies by hemagglutination inhibition (HI) test or micro-neutralization (MN) test using a circulating representative strain of each subtype/lineage of influenza virus as the test antigen. The infections with influenza virus subtype/lineage was confirmed if there was a four-fold or more increase in titers of antibodies against circulating representative strain of the subtype/lineage of influenza virus. Factors influencing infection with influenza A (H3N2) and B/Victoria viruses were analyzed using univariable and multivariable logistic regression.Results:In November 2019, 800 study participants were enrolled in the cohort, including 340 children aged 6-17 years and 460 adults aged 18-59 years; 605 study participants (including 224 children and 381 adults) were followed up in July 2020 and their paired sera were obtained before and after the influenza season. 25.3% (153/605) of the participants were confirmed to be infected with at least one subtype/lineage of seasonal influenza virus by HI and MN tests. The overall incidence of influenza viruses of all subtypes/lineages in children was 44.2% (95% CI: 37.6%-50.8%) which was significantly higher than the incidence of 14.1% in adults (95% CI: 10.7%-17.7%). Children had the highest incidence of influenza A (H3N2) virus infection, followed by B/Victoria. MN or HI antibody titers in A (H3N2)[ OR=0.88 (95% CI: 0.84-0.93)] and B/Victoria[ OR=0.97 (95% CI: 0.95-0.99)] before the influenza season were significantly associated with whether children were infected with that subtype/lineage of influenza virus. Conclusions:The residents aged 6-59 years in Macheng city had a substantial incidence of seasonal influenza virus infection during the influenza season from winter 2019 to spring 2020. Notably, almost half of children aged 6-17 years have been infected with seasonal influenza virus. Higher titers of HI/MN antibodies against seasonal influenza virus before the influenza season would be likely to reduce the risk of infection with influenza A (H3N2) and B/Victoria.

ObjectiveTo explore the exposure-lag-response relationship between temperature and risk of varicella incidence，and to provide a scientific evidence for early warning and precise prevention and control of varicella epidemic. MethodsDaily varicella cases and daily meteorological data were collected in Minhang District， Shanghai from 2010 to 2022. A distributed lag nonlinear model was used to determine the exposure-lag-response relationship between temperature and risk of varicella incidence. Furthermore， effect of temperature on the incidence risk was determined across different age groups. ResultsIn 2010‒2022， the total number of notified varicella cases was 26 207 in Minhang District， with the highest incidence in the group aged 3‒14 years （50.35%）. The seasonal pattern of daily varicella cases showed a double peak. The large peak was found in November and December， followed by a smaller peak in May and June. Moreover， the distributed lag nonlinear model showed a unimodal curve in the relationship between temperature and varicella incidence. The RR value reached its maximum peak of 1.90 （95%CI： 1.25‒2.87） at 7 ℃. A reverse U-shape was found in the lag-response curves between temperature and varicella incidence. Furthermore， the effect of temperature on the varicella incidence showed a unimodal pattern in the varicella cases aged 3‒14 years. The RR value reached its peak at 11 ℃ （RR=2.89， 95%CI： 1.33‒6.24）. In contrast， the effect of temperature on the varicella incidence in the cases aged 15 years and above showed a unimodal pattern， with RR value reaching the peak at 5 ℃ （RR=2.14， 95%CI： 1.33‒3.44）. ConclusionThe unimodal curve is found in the relationship between temperature and varicella incidence. Low temperature is associated with increased risk of varicella incidence. Children aged 3‒14 years are more susceptible to the effect of temperature on the varicella incidence.

Objective To investigate the relationship between serum histone deacetylase 4(HDAC4)and myeloid differentiation protein 88(MYD88)levels and hemorrhagic transformation after intravenous throm-bolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute cerebral infarction(ACI).Methods A total of 169 patients with ACI who were treated with rt-PA intravenous thrombolysis in this hospital from May 2020 to May 2022 were selected as the research objects,and they were divided into transformation group(46 cases)and non-transformation group(123 cases)according to whether hemorrhagic transformation occurred after rt-PA intravenous thrombolysis.In addition,156 healthy people who underwent physical examination in the hospital during the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the serum levels of HDAC4 and MYD88 in each group,and the gen-eral data of transformation group and non-transformation group were compared.Pearson correlation was used to analyze the correlation between serum HDAC4 and MYD88 levels in ACI patients.Multivariate Logistic re-gression analysis was used to analyze the related factors of hemorrhagic transformation in ACI patients after intravenous thrombolysis with rt-PA.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of HDAC4,MYD88 levels and their combination for hemorrhagic transformation in ACI patients after rt-PA intravenous thrombolysis.Results The serum level of HDAC4 in ACI group was signifi-cantly lower than that in control group,and the serum level of MYD88 in ACI group was significantly higher than that in control group(P＜0.05).There were no significant differences in gender,age,body mass index,fasting blood glucose,hyperlipidemia,and coronary heart disease between the non-transformation group and the transformation group(P＞0.05),while there were significant differences in atrial fibrillation,National In-stitute of Health Stroke Scale(NIHSS)score,and the time from onset to thrombolysis between the two groups(P＜0.05).The level of serum HDAC4 in transformation group was lower than that in non-transfor-mation group,and the level of serum MYD88 in transformation group was higher than that in non-transforma-tion group,and the difference was statistically significant(P＜0.05).Pearson correlation analysis showed that serum HDAC4 level was negatively correlated with MYD88 in ACI patients(r=-0.401,P＜0.001).Multi-variate Logistic regression analysis showed that atrial fibrillation,time from onset to thrombolysis,NIHSS score and MYD88 level were the risk factors for hemorrhagic transformation in ACI patients after rt-PA intra-venous thrombolysis,HDAC4 level was a protective factor for hemorrhagic transformation in ACI patients af-ter intravenous thrombolysis with rt-PA(P＜0.05).The area under the curve(AUC)of combined HDAC4 and MYD88 was 0.876,and the sensitivity and specificity were 65.22％and 98.37％,respectively,which was better than that of HDAC4 and MYD88 alone(Zcombined-HDAC4=2.298,P=0.022;Zcombined-MYD88=2.5 4 5,P=0.011).Conclusion The serum levels of HDAC4 and MYD88 in ACI patients are closely related to hemor-rhagic transformation after intravenous thrombolysis with rt-PA.

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 MRI features and pathological basis of diffuse midline glioma(DMG)with H3 K27 mutation and to improve the understanding of the clinical and preoperative diagnosis.Methods The imaging,histopathological,molecular pathological and prognostic data of 17 cases DMG with H3 K27 mutation confirmed by pathology were analyzed retrospectively.Results All regions located in midline areas and showed diffuse growth.There were 7 cases located in thalamus(1 case involved bilateral thalamus),3 cases in brainstem.Two cases involved thalamus and brainstem simultaneously.Two cases involved cervical spinal cord.Two cases involved ventriculus tertius and fourth ventricle.One case located in cerebella.Most lesions showed mixed signals,mainly with long signal on T1WI and long signal on T2WI.And 9 cases showed slightly narrow strip peritumoral edema and 8 cases showed no peritumoral edema.Of all cases,there were 9 cases with non-enhancement intensity,8 cases with diverse enhancement patterns.A total of 15 cases underwent fluid attenuated inversion recovery(FLAIR)scans,5 cases showed the T2/FLAIR imaging mismatching characteristics.Six cases were complicated with small cystic necrosis and 5 cases with intra-tumoral hemorrhage.Conclusion DMG with H3 K27 mutation has specific locations and MRI characteristics,including diverse contrast-enhancement patterns,non-or slightly narrow strip peritumoral edema.However,the definite diagnosis depends on pathological results.

Objective:To evaluate the clinical efficacy and safety of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in the treatment of lower pole kidney stones with a diameter <1.5 cm.Methods:The data of 95 patients with lower pole kidney stones with a diameter <1.5 cm treated in Renmin Hospital of Wuhan University from June 2017 to October 2020 were retrospectively analyzed. According to different surgical methods, the patients were divided into RIRS group and mini-PCNL group. There were 51 cases in RIRS group and 44 cases in mini-PCNL group. There was no significant difference in age [(48.2±11.4) years vs. (46.4±14.1) years], body mass index [(21.9±2.4) kg/m 2 vs. (20.7±3.2) kg/m 2], gender [male/female: 37/14 vs. 24/20], stone CT [(746.42±164.24)HU vs. (858.62±148.72)HU], creatinine [(71.3±21.6)μmol/L vs. (63.5±20.3)μmol/L], stone location (left/right: 26/25 vs. 23/21), stone diameter [(10.5±2.1) mm vs. (12.5±2.4) mm], infundibulopelvic angle [(43.32±9.42) degrees vs. (43.82±10.34) degrees], infundibular length [(24.92±4.85)mm vs. (24.37±5.26)mm] and infundibular [(9.26±3.04)mm vs.(9.46±2.94)mm] between the two groups ( P>0.05). The operation time, stone-free rate, hospital stay and postoperative complications between the two groups were compared. Results:Compared with the mini-PCNL group, the RIRS group had significantly smaller decrease in postoperative hemoglobin [(1.53±0.92) g/L vs. (4.54±2.46) g/L, P<0.05], the postoperative hospital stay was shorter [(2.52±0.94) d vs. (4.51±1.25)d, P<0.05], and postoperative visual analogue score was lower [(2.43±0.92) vs. (3.24±0.76), P<0.05]. The operation time of the mini-PCNL group was shorter than that of the RIRS group [(42.32±13.28) min vs. (54.24±14.43)min, P<0.05]. There was no significant difference in postoperative complications [5.9% (3/51) vs. 11.4% (5/44), P>0.05], postoperative cveatinine [(71.3±21.6) μmol/L vs. (63.5±20.3) μmol/L, P>0.05], postoperative intestinal function recovery time [(25.46±10.28)h vs. (32.43±9.25)h, P>0.05] and stone-free rate [92.2% (47/51) vs. 97.7% (43/ 44), P>0.05] between the two groups. Conclusions:Both RIRS and mini-PCNL are effective and safe minimally invasive treatments for lower pole kidney stones with a diameter < 1.5 cm. RIRS has shorter operation time, less blood loss, lower pain score and faster postoperative recovery.

Objective:To investigate the relationship between the expression of CD103 +CD8 +T cells in locally advanced oral squamous cell carcinoma (LA-OSCC), and the response to neoadjuvant chemoimmunotherapy (NACI). Methods:Thirty LA-OSCC patients from the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, who underwent NACI from June 2020 to December 2022 were analyzed, including 16 responders and 14 non-responders. Using multiple immunofluorescence technique to stain sections of patients to verify the correlation between the expression of CD103 +CD8 +T cells and the efficacy of NACI. CD103 +CD8 +T cell density was counted using Inform and HALO software. The Spearman correlation coefficient in rank correlation is used to describe the correlation between CD103 +CD8 +T cell and neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII) It′s effectiveness as a predictive marker to NACI was analyzed by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Two-tailed t-test or Mann-Whitney U-test was used to compare data between two groups, and one-way ANOVA was used to compare data between multiple groups. SPSS 22.0 and GraphPad prism 9.0 software were used for statistical analysis and plotting of relevant statistical graphs such as histograms. P<0.05 was considered a statistically significant difference. Results:The density of CD103 +CD8 +T cells has expanded in advanced OSCC patients who are responsive to NACI. The CD103 +CD8 +T cell densities in the responsive and nonresponsive groups were 118.30(41.92, 197.80) pcs/mm 2 and 21.63(4.91, 71.92) pcs/mm 2 respectively, with statistically significant differences( U=52.00, P=0.012). CD103 +CD8 +T cell abundance was negatively correlated with NLR, dNLR, PLR, and SII ( P<0.05). ROC curve analysis showed that the AUC for predicting efficacy of NLR, dNLR, PLR, and SII were 0.781 ( P=0.009, 95% CI: 0.5715-0.9910), 0.671 ( P=0.105, 95% CI: 0.467-0.881), 0.679 ( P=0.020 95% CI: 0.549-0.951), 0.750 ( P=0.096, 95% CI: 0.461-0.896), respectively. The AUC for CD103 +CD8 +T cells alone was 0.861 ( P=0.013, 95% CI: 0.585-0.950), and the AUC of combining CD103 +CD8 +T cells with NLR was 0.896 ( P=0.025, 95% CI: 0.454-0.938). Conclusions:The density of CD103 +CD8 +T cells is expanded in advanced OSCC patients who are responsive to NACI. CD103 +CD8 +T cells positively predict favorable responses as a strong indicator to NACI in advanced OSCC patients. Co-interpretation of CD103 +CD8 +T cells and NLR value enhances the predictive accuracy of NACI in advanced OSCC patients.

Objective To investigate the influence of internal and external sphincter loss synergy on stress distributions and urine flow rates of lower urinary tract organs and tissues. Methods Based on collodion slice, the geometric model of the lower urinary tract was reconstructed, and finite element model of the lower urinary tract with muscle active force was established. Through fluid structure coupling simulation, the changes of tissue stress and urine flow rate were simulated under four conditions: normal contraction of internal and external sphincter, total loss of muscle active force and single loss of muscle active force for internal and external sphincters at the end of urination. Results The urethral stress changes in normal contraction of internal and external sphincter muscles were the same as the clinically measured urethral pressure changes. Compared with normal contraction, when the internal sphincter lost its muscle active force alone, stress of the internal sphincter and the urethra of the prostate was reduced by 33.6% and 13.8%, and flow rate of urine in this position was also reduced. When the external sphincter lost its muscle active force alone, the urethral stress of the external sphincter and external urethra was reduced by 59.5% and 24.03%, respectively. When the internal and external sphincter lost muscle active force, stress of the internal sphincter, the prostate, the external sphincter and the external urethra were reduced by 38.77%, 18.6%, 63.58%, 29.74%, respectively, and flow velocity in the corresponding position was also reduced. Conclusions Internal and external sphincter loss synergy resulted in the difference of tissue stress and urine flow rate. The results can provide the theoretical basis for surgical treatment of urinary incontinence caused by sphincter.

Objective    To evaluate whether long frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection. Methods    From 2018 to 2019, 172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital. They were divided into two groups according to the length of FET: patients treated with stents of 100 mm in length were enrolled into a short FET group, and those with stents of 150 mm in length into a long FET group. There were 124 patients in the short FET group, including 108 (87.1%) males and 16 (12.9%) females with a mean age of 51.8±7.9 years. There were 48 patients in the long FET group, including 44 (91.7%) males and 4 (8.3%) females with a mean age of 50.6±9.7 years. The clinical data and prognosis of the patients were analyzed. Results    The mean distal stent graft was at the level of T 8.5±0.7 in the long FET group, and at the level of T 6.8±0.6 in the short FET group (P=0.001). Sixteen patients died after operation in the two groups, including 13 (10.5%) in the short FET group and 3 (6.2%) in the long FET group (P=0.561). There were 7 patients of spinal cord injury in the two groups, including 6 (4.8%) in the short FET group and 1 (2.2%) in the long FET group (P=0.675). There was no statistical difference in other complications between the two groups. The follow-up time was 16.7 (1-30) months. During the follow-up, 2 patients died in the long FET group and 5 died in the short FET group. No new spinal cord injury or distal reintervention occurred during the follow-up. Conclusion    Long FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.