Objective:To observe the clinical evolution process and imaging characteristics of choroidal lesions in different subtypes of serpiginous choroiditis (SC), and to explore the clinical significance of subtype classification.Methods:A retrospective, uncontrolled and observational study. A total of 45 eyes of 25 SC patients diagnosed in Yunnan Eye Hospital from May 2009 to September 2021 were included in the study. According to the initial location of the lesion and fundus images, including fundus color photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and other examination results. SC was divided into peripapillary serpiginous choroiditis, macular serpiginous choroiditis and ampiginous choroiditis. According to the shape of the lesions at the first diagnosis, it can be divided into new lesions with only infiltrating edema, old lesions with only atrophy and recurrent lesions with coexistence of edema and atrophy. the imaging features, development and complications of different subtypes of ocular lesion were observed.Results:Among the 45 eyes of 25 cases, 15 cases were male and 10 cases were female, 20 cases of binocular and 5 cases of monocular, age was 42.3±5.7 years old. There were 21 eyes with active lesions, of which 5 eyes were new lesions and 16 eyes with recurrent lesions; 24 eyes were old lesions. Concurrent optic disc edema occurred in 3 eyes; mild vitreitis occurred in 5 eyes; retinal occurred vasculitis in 3 eyes; choroidal neovascularization occurred in 3 eyes. Among the 16 cases (64%, 16/25) of the peripapillary serpiginous choroiditis, 2 cases (2 eyes) were monocular, and 14 cases (28 eyes) were binocular. Active lesions were found in 16 eyes, of which patients with binocular lesions only one had active lesions. The choroidal lesions that were close to the optic disc or around the optic disc, expanded outwards centrifugally with the prolongation of the disease course, and can progress to the macula. The edge of the lesion was tortuous, with a geographic-like, amoeboid-like and finger-like, polypoid or propeller-like shape. Active lesions in FFA showed weak fluorescence in the early stage and strong fluorescence in the late stage; the old lesions showed weak fluorescence in the early stage and mottled fluorescence in the late stage, and mostly strong fluorescence on the edge. OCT showed thickening of active lesions and thinning of old lesions. Among the 4 cases (16.0%, 4/25) of macular type, 2 cases (2 monocular eyes) had active lesions; 2 cases (4 eyes) had lesion in both eyes, among them, 1 case (2 eyes) had old lesion, and the other case had alternate active lesions. The initial lesions were all located in the off-center of the macula, and most of them were disk-shaped and progressing centrifugally to the periphery. The FFA and OCT imaging findings of the lesions were similar to those of the peridisc type. Among the 5 cases (20.0%, 5/25) of ampiginous choroiditis, 1 case (1 eye) was monocular and 4 cases (8 eyes) were binocular. These lesions were multiple old lesions of varying sizes, gray-white with pigmentation, with clear borders in the posterior pole. Among them 4 eyes have new active lesions appeared near the old lesions. The old lesions showed weak fluorescence with clear borders, and the fluorescein leakage at the late edge formed a strong fluorescence ring; the active lesions showed weak fluorescent spots with blurred edges, and the fluorescence was slightly enhanced in the late stage. In old lesions, atrophy of the photoreceptor layer, RPE and choroid can be seen, and RPE hyperplasia in some areas.Conclusions:SC subtype is a classification of the location of the first lesion, but the characteristics of the repeated attack of this disease can lead to the annihilation of each subtype due to the continuous expansion of the lesion. The phenomenon that the fundus active lesions only occur in one eye that can explain the clinical manifestations of asymmetric morphology of binocular lesions. The characteristics of binocular subtype warn that the predilection site of the healthy eye should be paid attention to.

OBJECTIVE: Bufalin is an effective drug for the treatment of liver cancer. But its high toxicity, poor water-solubility, fast metabolism and short elimination half-life limit its use in tumor treatment. How to make the drug accumulate in the tumor and reduce side effects while maintaining its efficacy are urgent problems to be solved. The goal of this study is to solve these problems. METHODS: A copolymer with tunable poly-N-isopropylacrylamide and polylactic acid was designed and synthesized. The corresponding dual targeting immunomicelles (DTIs) loaded with bufalin (DTIs-BF) were synthesized by copolymer self-assembly in an aqueous solution. The size and structure of DTIs-BF were determined by ZetaSizer Nano-ZS and transmission electron microscopy. Then, its temperature sensitivity, serum stability, critical micelle concentration (CMC), entrapment efficiency (EE), drug release and non-cytotoxicity of blank block copolymer micelles (BCMs) were evaluated. Next, the effects of DTIs-BF on cellular uptake, cytotoxicity, and tumor cell inhibition were evaluated. Finally, the accumulation of DTIs-fluorescein isothiocyanate (FITC) and the in vivo anti-tumor effect were observed using an interactive video information system. RESULTS: DTIs-BF had a small size, spherical shape, good temperature sensitivity, high serum stability, low CMC, high EE, and slow drug release. The blank BCMs had very low cytotoxicity. Compared with free bufalin, the in vitro cellular internalization and cytotoxicity of DTIs-BF against SMMC-7721 cells were significantly enhanced, and the effects were obviously better at 40 °C than 37 °C. In addition, the therapeutic effect on SMMC-7721 cells was further enhanced by the programmed cell death specifically caused by bufalin. When DTIs-FITC were injected intravenously in BALB/c nude mice bearing liver cancer, the accumulation of FITC was significantly increased in tumors. CONCLUSION DTIs-BF is a potentially effective nano-formulation and has broad prospects in the clinical treatment of liver cancer.
Animals ; Antineoplastic Agents/pharmacology* ; Bufanolides ; Cell Line, Tumor ; Liver Neoplasms/drug therapy* ; Mice ; Mice, Inbred BALB C ; Mice, Nude

Objective:To understand the current situation of smartphone addiction and mental health of medical freshmen, and conduct research on the relationship between smartphone addiction and mental health, so as to provide evidence for the prevention and intervention of smartphone addiction among medical freshmen.Methods:A stratified random sampling method was used to select 279 freshmen in the medical profession of Binzhou Medical University as the research objects, and the revised smartphone addiction scale (SAS-C) and mental health symptom self-rating checklist scale (SCL-90) were selected for testing. SPSS 19.0 was used for t test. Results:A percentage of 29.71 medical freshmen had smartphone addiction problems, which was generally above average. The SCL-90 total scores and the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, psychosis and other factors in the smartphone addiction group were significantly higher than those in non-smartphone addiction group. The total score of smartphone addiction in medical professional freshmen was significantly correlated with the total score of SCL-90. In addition to the interference factors of daily life, other factors had positive correlation with various factors of SCL-90. Interpersonal sensitivity and obsessive-compulsive symptoms had a significant predictive effect on smartphone addiction (β=0.24, 0.26, P < 0.01), which were important variables affecting mobile phone addiction of medical freshmen. Conclusion:Many medical freshmen have the problem of smartphone addiction, which may cause a series of psychological problems, especially obsessive-compulsive symptoms, interpersonal sensitivity, anxiety and psychosis.

Objective:To analyze the OCT angiography (OCTA) features of eyes affected with angioid streaks.Methods:Retrospective analysis of 26 patients (52 eyes) diagnosed as angioid streaks by multimodal imaging in Ophthalmology Department of Yunnan Second People’s Hospital from May 2017 to February 2019 were included in this study. There were 18 males and 8 females, with the mean age of 50.8±6.9 years. All the patients were binocular. There were 34 eyes in 20 patients with CNV. Among them, 13 eyes had a course of disease within 1 month, 16 eyes had a course of disease over 1 month, and 5 eyes were treated with anti-VEGF drugs. All patients were examined by ultra-wide-angle fundus photography, infrared fundus imaging (IR), spectral-domain OCT, FAF and FFA. At the same time, the Heidelberg OCTA instrument was used for OCTA examination. The central wavelength was 840 nm, the acquisition speed was 85,000 times/s, and the width was 45 nm. A 3 mm × 3 mm scan was obtained. Each cube consisted of two 304 B scans of repeated volumes, and motion correction was performed using two orthogonally captured image volume registration. The results of fundus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.dus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.Results:Among 52 eyes, 40 eyes showed choroidal capillary shadows in OCTA, and no obvious abnormal OCTA images in 12 eyes. Ten eyes OCTA showed a vascular network beseide the optic disc, FFA showed fluorescent staining instead of fluorescein leakage. Among the 52 eyes, 34 eyes had secondary macular CNV, and 34 eyes had different forms of CNV. Different forms had a certain correlation with the length of medical history and treatment history. Among them, 13 eyes with short course of disease (less than 1 month) and untreated patients had smaller flower-ring morphology, 16 eyes with longer course (more than 1 month) but no treatment had larger fan-shaped segments, and 5 eyes with anti-VEGF therapy were trimmed after the dendritic shape.Conclusions:AS streaks appeared no blood flow signal area in OCTA, and repairing vascular network beside the optic disc can be observed in some AS patients. The CNV performance with different disease course and treatment experience is different.

Objective:To observe the clinical and imaging characteristics of acute idiopathic macular degeneration (AIM).Methods:A retrospective clinical study. From March 2016 to January 2018, 5 eyes (5 AIM patients) in The Second People's Hospital of Yunnan Province were included in the study. Among them, there were 4 males (4 eyes) and 1 female (1 eye); all patients were monocular with the average age of 34.2 years. The course of illness from onset of symptoms to treatment was 4-22 days. All affected eyes were examined by BCVA, fundus color photography, OCT, FAF, and FFA. Among 5 eyes, 1 eye with optic disc vasculitis was given oral glucocorticoid treatment; 4 eyes were not interfered after the diagnosis.Results:The follow-up time was 6 months. During follow-up, BCVA, fundus color photography, and OCT examination were performed. The results were all a sudden decrease in monocular vision, accompanied by visual distortion or central dark spots. At the first visit, the BCVA was 0.1, 0.2, 0.2, 0.05, and 0.5; at the last follow-up, the BCVA of the affected eye was 0.8, 0.6, 0.5, 0.5, and 1.0, respectively. Fundus color photography showed that at the first diagnosis, all the affected eyes showed irregular round yellow-white lesions in the macular area, including 1 eye with small patches of hemorrhage and 1 eye with pseudopyous changes in the macular area. Two to three weeks after the initial diagnosis, the yellowish-white lesions and bleeding in the macular area were basically absorbed. The center of the lesion showed weak pseudopod-like fluorescence, and the surrounding area was surrounded by strong fluorescence in FAF examination. The irregular and strong fluorescence in the early macular area and accumulation of late fluorescein in FFA examination. One eye was receivied glucocorticoid therapy. The upper layer of the retinal nerve in the macular area was detached, and the inferior space showed focal strong reflective material in 3 eyes in OCT examination. At the first diagnosis, the retinal neuroepithelial layer was detached, the top of the RPE layer was irregular with strong reflective material, and the structure of the ellipsoid zone and the chimera zone was unclear; as the course of the disease prolonged, the outer retinal structure recovered.Conclusions:AIM is characterized by inflammatory exudative changes in the outer layer of the retina in the macular area; FFA is characterized by strong subretinal disc-like fluorescence or multifocal weak fluorescence in the macular area; OCT mainly manifests as neuroepithelial detachment and changes in the outer retina and RPE, The structure can be restored by itself.

Objective To observe the multimodal imaging characteristics ofchoroidal metastasis.Methods A retrospective clinical observation study.From January 2016 to November 2018,28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People's Hospital of Yunnan Province were included in the study.There were 12 males and 16 females,with the mean age of 50.8±6.9 years.There were 18 unilateral patients and 10 bilateral patients.The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes).All patients underwent ultra-wide-angle fundus photography,infrared fundus imaging,fundus autofluorescence,FFA,frequency-domain OCT,and B-ultrasound examinations.Results In the ultra-wide-angle fundus photography,metastatic tumors were located in the posterior or middle part of the retina,of which 26 were isolated lesions and 12 were multifocal.A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes).There were 12 eyes with exudative retinal detachment.Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change,and the infrared photograph of the exudative retinal detachment area was relatively low.Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor,13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor;3 eyes of old lesions showed "leopard-like" autofluorescence.Among the 38 eyes in the fluorescein angiography,32 eyes of the early lesions showed low fluorescence,and the venous phase showed a needle-like high fluorescence point,and the post-leakage fluorescence gradually increased.Two eyes with old lesions showed a "leopard-like" change.In 38 eyes,OCT showed wavy ridges of the choroid and pigment epithelium,and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer.B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo.There were 23 eyes with flat shape,12 eyes with flat hemisphere,and 3 eyes with irregular shape.Conclusions Color photography of the fundus showed the size,location,pigmentation and peripheral retinopathy of the metastatic lesions.Infrared photography showed different reflex signals in the tumor,exudation,and atrophy.The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion.In the fluorescein angiography,the fresh tumor showed fluorescence leakage,while the atrophic tumor showed transmitted fluorescenc.OCT reflected the height of the lesion and the change of pigment epithelium.

Objective: To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. Methods: This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ² test and Cochran-Armitage trend analysis method. Results: Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). Conclusion The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

Objective To observe the OCT angiography imaging features of choroidal neovascularization (CNV) with different activity in age-related macular degeneration (AMD).Methods A retrospective case analysis.Forty-two eyes of 33 patients (21 males and 12 females,aged 65.3 ± 8.61 years) who were diagnosed with AMD by multi-mode fundus imaging examination at the Ophthalmology Department of Yunnan Second People's Hospital during January 2017 and October 2018 were enrolled in this study.All patients underwent BCVA,slit-lamp biomieroscopy,indirect ophthalmoscopy,fundus colorized photography,FAF,FFA and OCT examinations.The patients were divided into active CNV (27 eyes of 19 patients) and inactive CNV (15 eyes of 14 patients) by comprehensive analysis of fundus imaging characteristics and treatment process.The imaging features of OCTA in the two groups were compared.The number of eyes of each active or inactive indicator in the active CNV group and the inactive CNV group was calculated,and the composition ratio of each group of the indicators was subjected to the x2 test.Results Among the 27 eyes of active CNV,22 eyes (81.5％) of OCTA showed abundant small capillary branching structure,while 13 eyes (13.3％) of 15 eyes of inactive CNV showed more coarse blood vessel.Among the 27 eyes of active CNV,26 eyes (96.3％) of OCTA showed that the marginal vascular end points of CNV lesions were "arcaded" or "ring",while 12 eyes (80.0％) of 15 eyes of inactive CNV showed the presence of isolated branches of peripheral vessels.Among the 27 eyes with active CNV lesions,there were no large feeder vessels inside the lesions,and 8 (53.3％) of the 15 inactive CNV lesions showed feeder vessels in the center of the lesion.Among the 27 eyes with active lesions,23 eyes (85.2％) of OCTA showed a low-reflection "halo" around the CNV lesion,and no low-reflection "halo" structure was observed in the 5 eyes of the inactive CNV lesion.The statistical results showed that there were abundant small blood vessel branches (x2=22.759,P=0.000),annular anastomosis around the lesion (x2=31.704,P=0.000),lowreflection halo (x2=32.327,P=0.000),and large nourishing blood vessels (x2=26.063,P=0.000),dilated choroidal vessels (x2=32.912,P=0.000).All the above indicators were statistically different between the two groups.Conclusion The abundant small vessel branches in OCTA,the surrounding anastomosis in a ring structure and the low reflex halo around the lesion are markers of active CNV,while the large feeding vessels and dilated choroidal vessels are indicators of inactive CNV.

Objective To report epidemiological data on neonatal pain collected from a geographi-cally defined region,and analyze its influencing factors. Methods We prospectively collected data on all painful procedures from the first 3 days of admission from 106 premature by using self-made questionnaire. Results One hundred and six premature infants experienced 8 167 first-attempt procedures during the first 3 days of admission,26 painful procedures per premature per day. The top seven were respectively plaster re-moval 1 661(20. 3%),nasal aspiration 1 416(17. 3%),blood sugar testing 982(12. 0%),foil removal 833 (10. 2%),intravenous cannula 806(9. 9%),removal of intravenous line 803(9. 8%),arterial puncture 696 (8.5%); 640(7.8%)supplemental attempts were performed. Arterial puncture 274(42.8%)and intrave-nous cannula 235 (36. 7%) were the top two painful procedures easily failed. Non-invasive ventilation,me-chanical ventilation,neonatal respiratory distress syndrome and low weight were the risk factors of painful procedures. Conclusion In neonatal intensive care unit,large number of painful procedures are performed in the first 3 days of admission. Healthcare providers should develop individualized measures to promote the man-agement of premature pain.

This paper introduced the present situation and the existing problems of palliative care and hospice care system in Russia.The coverage of palliative is narrow,regional development is not balanced,the medical professionals in palliative care is lack,the professional skills should be improved urgently,the training system of palliative care is not perfect and the quality of training is not high,the medical professionals have high work pressure,the brain drain is serious,the social cognition is not enough,the volunteer service system is underdeveloped,and the acquisition rate of mental and narcotic drugs is low.On the basis of the above,this paper introduced the development strategy of Russian palliative care,and discussed the enlightenment to our country.For example,government departments should attach importance to the introduction of legal norms of palliative care,perfect the service system of palliative care,establish the supporting facilities,reasonably plan palliative care system,implement the integration of service management and scientific research,and bring the guarantee palliative care fund into the national budget.