Recent years have witnessed significant advancements in myopia control research through the application of diffuse optical technology(DOT)spectacle lenses. Myopia has emerged as a global public health challenge, affecting nearly half of the world's population, with childhood and adolescent myopia rates continuing to rise. DOT lenses represent an innovative myopia control intervention based on retinal contrast signal theory. These lenses incorporate micro-light scattering dots distributed across the lens surface to reduce retinal imaging contrast and modulate the influence of visual input on axial elongation, thereby slowing myopia progression. The core mechanism operates through refractive index differences between the lens substrate(1.53)and scattering dots(1.50), which generate optical scattering effects. This design maintains clear vision through a central 5 mm optical zone while effectively reducing contrast signal intensity in the peripheral retina. Large-scale randomized controlled trials, including the CYPRESS study, have demonstrated significant myopia control efficacy in children aged 6-10 years: 12-month follow-up data revealed a 74% reduction in myopia progression and a 50% reduction in axial elongation, with sustained safety and visual quality maintained over 4-year long-term follow-up. However, several aspects of DOT technology remain contentious and require further clinical validation, including its applicability across different age groups, optimal scattering dot density configurations, combined application effects with other myopia control methods, and long-term visual adaptation during extended use. This review systematically examines the theoretical foundations, design characteristics, clinical application progress, and future development directions of DOT technology, providing scientific evidence for clinical myopia prevention and control strategy formulation.

Objective:To summarize long-term clinical follow-up results of segment instability between the upper instrumented vertebra (UIV) and the adjacent upper vertebra (UIV+1) and to establish the optimal timing for surgery for UIV+1.Methods:A retrospective analysis was conducted on 265 patients with lumbar degenerative diseases who underwent transforaminal lumbar interbody fusion (TLIF) surgery at the Department of Spinal Surgery, Zhongda Hospital, from January 2014 to December 2018. The cohort included 119 male and 146 female patients, with an average age of 64.93 years (range: 32-86 years). Preoperative dynamic imaging measured sagittal angulation (SA) and sagittal translation (ST) of the UIV+1/UIV segment. Patients with SA>10° or ST>2 mm were categorized into the unstable group, further divided into the unstable non-fusion group and the unstable fusion group based on whether UIV+1 expansion fusion was performed. The remaining patients were classified into the stable group. Imaging indicators, Visual Analogue Scale (VAS) scores, Oswestry disability index (ODI) scores, and Japanese Orthopaedic Association (JOA) scores were compared among the groups, with JOA improvement rates calculated to assess clinical efficacy. Pearson correlation coefficient analysis was employed to examine correlations between preoperative imaging indicators and final follow-up JOA improvement rates. Receiver Operating Characteristic (ROC) curves and the maximum Youden index were utilized to determine thresholds for preoperative SA and ST.Results:The follow-up duration for all patients was 73.53±12.92 months (range: 61-108 months). The stable group (124 cases) included 61 males and 63 females, aged 64.31±9.83 years (range: 44-82 years). The unstable non-fusion group (59 cases) included 22 males and 37 females, aged 65.76±11.01 years (range: 32-86 years). The unstable fusion group (82 cases) included 36 males and 46 females, aged 65.26±8.68 years (range: 47-80 years). At the last follow-up, the unstable non-fusion group exhibited ΔSA 0.90°±1.97° and ΔST 0.77±1.27 mm, both significantly higher than the stable group's ΔSA 0.25°±1.57° and ΔST 0.34±0.34 mm ( t=3.564, P<0.001; t=2.311, P=0.022). Clinical improvements were lower in the unstable non-fusion group compared to the other two groups: VAS (2.28±0.83), ODI (5.91%±3.46%), JOA (24.11±1.78), with a JOA improvement rate of 60%. The stable group showed VAS (1.51±0.69), ODI (3.71%±1.75%), JOA (27.33±1.91), with a JOA improvement rate of 83%. The unstable fusion group had VAS (1.46±0.83), ODI (3.46%±1.81%), JOA (26.48±1.66), with a JOA improvement rate of 78%. These differences were statistically significant ( F=32.117, P<0.001; F=24.827, P<0.001; F=92.658, P<0.001; F=93.341, P<0.001). The JOA improvement rate was negatively correlated with preoperative SA ( r=-0.363, P<0.001) to a low extent, and with preoperative ST ( r=-0.596, P<0.001) to a moderate extent. ROC curve analysis determined the preoperative SA threshold as 11.5° and the preoperative ST threshold as 1.85 mm. Conclusion:Pre-existing instability of the responsible segment UIV and UIV+1 (SA>10° or ST>2 mm) may worsen during long-term follow-up after TLIF. When preoperative SA exceeds 11.5° and ST exceeds 1.85 mm between UIV and UIV+1, performing an extended fusion involving UIV+1 can ensure surgical efficacy over long-term follow-up.

Objective:To investigate the clinical value of endoscopic ultrasound elastography versus contrast-enhanced computed tomography in the risk stratification of gastrointestinal stromal tumors (GISTs). Methods:Clinical and imaging data were obtained from 77 patients who were confirmed to have GISTs and underwent endoscopic or surgical treatment at Wenzhou Central Hospital between May 2019 and April 2021. Endoscopic ultrasound elastography based on a five-point scoring system and hypotonic gastrointestinal contrast-enhanced computed tomography were performed for preoperative risk stratification of GISTs. The two techniques were compared in terms of the accuracy of preoperative risk stratification of GISTs. The imaging features of the two techniques were summarized.Results:According to the postoperative pathological results, 13 patients were at high risk, 13 patients were at medium risk, 35 patients were at low risk, and 16 patients were at extremely low risk. These patients were divided into two groups according to postoperative pathological results: a low-risk group (low risk + extremely low risk) and a medium- and high-risk group (high + medium risk). In the low-risk group ( n = 51), 42 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs and were recommended to receive endoscopic treatment, while the rest 9 patients were identified to have medium-risk GISTs. Contrast-enhanced computed tomography findings revealed that 30 patients had low-risk GISTs and were recommended to receive endoscopic treatment, and 21 patients had medium-risk GISTs. In the medium- and high-risk group ( n = 26), 4 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs, and 22 patients had medium- or high-risk GISTs. Contrast-enhanced computed tomography findings revealed that 9 patients were identified to have low-risk GISTs, and 17 patients had medium- or high-risk GISTs. Endoscopic ultrasound elastography yielded an overall diagnostic accuracy of 83.11% (64/77), while contrast-enhanced computed tomography had an overall diagnostic accuracy of 61.04% (47/77). Endoscopic ultrasound elastography outperformed contrast-enhanced computed tomography in accurate risk stratification of GISTs ( χ2 = 4.66, P < 0.05). In terms of predicting high-risk GISTs, endoscopic ultrasound elastography had a sensitivity of 84.62% and a specificity of 82.35%, both were higher than those of contrast-enhanced computed tomography (sensitivity: 65.38%; specificity: 58.82%), but the differences in sensitivity and specificity between the two techniques were not significant (sensitivity: Fisher's exact test P = 0.590, specificity: χ2 = 0.93, P > 0.05). Conclusion:Endoscopic ultrasound elastography appears to have a better overall diagnostic accuracy in the risk stratification of GISTs compared with contrast-enhanced computed tomography. The combined use of these two techniques may offer a better comprehensive understanding of the perilesional structure and organ involvements and distant metastasis than a single technique, thereby providing a reliable reference for the choice of treatment for GISTs.

Objective:To study the risk factors of patients with hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization(TACE) refractoriness.Methods:The clinical data of 106 HCC patients who underwent TACE at the Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2021 were retrospectively studied. There were 90 males and 16 females, with the age of (59.9±9.3) years. These patients were divided into the TACE-refractory group ( n=47) and the control group ( n=59) based on whether TACE refratoriness occurred after surgery. Serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVIKA-II), maximum diameter of tumor, number of tumor and tumor vascularization patterns between the two groups were compared. Multivariate logistic regression analysis was performed to analyse the risk factors of TACE refractoriness in patients with HCC after TACE. Results:The proportion of patients with AFP >400 μg/L, PIVIKA-II >40 AU/L, number of tumor and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement) were significantly higher in the TACE-refractory group than the control group (all P<0.05). The maximum diameter of tumor for patients in the TACE-refractory group was significantly larger than that in the control group ( Z=-2.41, P=0.016). Multivariate logistic regression analysis showed that patients with serum AFP >400 μg/L( OR=2.707, 95% CI: 1.008-7.271), multiple tumors ( OR=6.069, 95% CI: 2.115-17.415) and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement)( OR=7.813, 95% CI: 2.246-27.176) before the first TACE were at increased risks of TACE refractoriness (all P<0.05). Conclusion:Preoperative AFP >400 μg/L, multiple tumors and tumor vascularization patterns Ⅲ+ Ⅳ were independent risk factors for TACE refractoriness in patients with HCC.

Objective To study the mechanism of overexpression of retinoic acid receptor alpha( RARα)in attenuating renal interstitial fibrosis(RIP)in rats. Methods Porty 6_week_old male SD rats were randomly divided into 4 groups:sham operation group,model group,negative control group and transfection group,with 10 rats in each group. Rats in model group were separated and double ligated with left ureter;rats in sham operation group were not li_gated with ureter;rats in transfection group and negative control group were transfected with adeno_associated virus and negative control virus carrying RARα gene on the basis of model group,respectively. All rats were sacrificed 2 weeks later. Left kidney tissues were taken for pathological examination and RIP index was calculated. The expression of colla_genⅣ(Col_Ⅳ)and fibronectin(PN)in renal tissue was detected by using immunohistochemistry. The expressions of RARα,prohibitin(DHB)and transforming growth factor_beta 1(TGP_β1)in renal tissue were detected by using real_time fluorescence quantitative polymerase chain reaction( RT _qDCR)and Western blot. Results (1)Com_pared with sham operation group,the RIP index was significantly increased in model group(22. 81 ± 2. 43 vs. 2. 34 ± 0. 55,q﹦24. 94,P〈0. 05);compared with model group,the RIP index was not of significant difference in negative control group(22. 81 ± 0. 43 vs. 22. 26 ± 3. 43,q﹦0. 67,P〉0. 05),however it significantly decreased in transfection group(14. 06 ± 2. 99 vs. 22. 81 ± 2. 43,q﹦10. 66,P〈0. 05).(2)Compared with sham operation group,the mRNA and protein expressions of RARα,DHB significantly decreased in model group,but TGP_β1 mRNA and protein,Col_Ⅳand PN protein expression significantly increased in model group( mRNA:0. 43 ± 0. 17 vs. 1. 00 ± 0. 00,0. 34 ± 0. 08 vs. 1. 00 ± 0. 00,2. 97 ± 0. 54 vs. 1. 00 ± 0. 00,all P〈0. 05;protein:0. 25 ± 0. 10 vs. 0. 51 ± 0. 06,0. 24 ± 0. 07 vs. 0. 58 ± 0. 04,0. 59 ± 0. 09 vs. 0. 33 ± 0. 06,16. 01 ± 0. 87 vs. 8. 79 ± 0. 39,14. 64 ± 0. 32 vs. 9. 36 ± 0. 59,all P〈0. 05);com_pared with model group,the mRNA and protein expressions of RARα,DHB,TGP_β1 and Col_Ⅳand PN protein ex_pression had no significant difference in negative control group(all P〉0. 05);compared with model group,the mRNA and protein expression of RARα,DHB mRNA and protein expression significantly increased,but the TGP_β1 mRNA and protein,Col_Ⅳ and PN protein expression significantly decreased in transfected group( mRNA:0. 86 ± 0. 07 vs. 0. 43 ± 0. 17,0. 89 ± 0. 11 vs. 0. 34 ± 0. 08,1. 65 ± 0. 28 vs. 2. 97 ± 0. 54,all P〈0. 05;protein:0. 40 ± 0. 07 vs. 0. 25 ± 0. 10,0. 45 ± 0. 10 vs. 0. 24 ± 0. 07,0. 43 ± 0. 08 vs. 0. 59 ± 0. 09,11. 57 ± 0. 33 vs. 16. 01 ± 0. 87,11. 67 ± 0. 53 vs. 14. 64 ± 0. 32,all P〈0. 05).(3)Correlation analysis revealed that RARα protein expression was negatively correlated with RIP index,Col_Ⅳ,PN,TGP_β1(r﹦ _0. 78,_0. 78,_0. 76,_0. 76,all P〈0. 05);DHB protein expression was negatively correlated with RIP index,Col_Ⅳ,PN,TGP _β1( r ﹦ _0. 87,_0. 87,_0. 88,_0. 75,all P 〈0. 05);RARα protein was positively correlated with DHB(r﹦0. 85,P〈0. 05). Conclusion Overexpression of RARα could attenuate RIP by enhancing DHB expression in rats subjected to unilateral ureteral obstruction.

Objective To observe the value of MRI in evaluation on the morphology and function of iliococcygeal muscles in fertile and nulliparous women.Methods Totally 50 healthy fertile women (fertile group,further divided into cesarean section subgroup and spontaneous delivery subgroup according to the mode of delivery) and 17 nulliparous healthy women (nulliparous group) underwent MR scanning in both natural and increased abdominal pressure state.Iliococcygeus thickness (ICT),coronal iliococcygeal angle (cICA) and sagittal iliococcygeal angle (sICA) of different states were measured and compared between the groups.Results In the natural state,the right and bilateral average sICA in the fertile group were larger than those in nulliparous group (both P＜0.05),while no statistical difference of ICT,right,left and bilateral average cICA and left sICA were found between two groups (all P＞0.05);the bilateral average sICA in spontaneous delivery subgroup was larger than that in cesarean section subgroup (P＜0.05).In increased abdominal pressure state,left,right sICA and bilateral average sICA in fertile group were larger than those in nulliparous group (all P＜0.05),while there was no statistical difference of ICT and cICA between two groups (all P＞0.05);no statistical difference of ICT,cICA nor sICA was found between spontaneous delivery subgroup and cesarean section subgroup (all P＞0.05).Conclusion MRI can accurately evaluate morphological and functional changes of iliococcygeal muscle in females.

Objective To investigate the effects of growth-discordant twin pregnancies on neonatal thyroid stimulating hormone (TSH) level and congenital hypothyroidism (CH).Methods A total of 3 444 live-birth twin neonates born between January 1,2012 and December 30,2014 in Ningbo City were enrolled.Blood samples via heel puncture were collected and tested.Incidence of CH in singleton and twin neonates was compared.Deviation of birth weight larger than 25％ in twin neonates was set as the criteria for discordant growth.TSH and 17 α-hydroxylase levels in CH twins and normal twins,with or without discordant growth,were compared.Chi-square and non-parametric statistics were performed for data analysis.Results The incidence of CH in twin neonates was 0.56％ (19/3 444),higher than that in singleton neonates [0.09％ (203/225 712),x2=76.225,P＜0.01].Among nineteen CH twins,CH occurred in both twins in eight cases (four twins) and in one of the twins in eleven cases.The gestational age at birth in the eight CH twins were less than 37 weeks,with four males and four females;five were low birth weight infants;one twin were dichorionic,and three twins were monochorionic.In the eleven cases of CH occurring in one of the twins,the gestational age was less than 37 weeks in nine cases,eight were low birth weight infants,six were male and five female;seven were monochorionic and four were dichoronic twins.Five cases of temporary hypothyroidism were all low birth weight infants among the growth-discordant twins.CH cases in growth-discordant group had lower birth weight than their normal twins [M(P25-P75),2 100 (1 800-2 600) vs 2 770 (2 530-2 960) g,Z=4.369],and a higher TSH level [15.4 (11.8-18.5) vs 6.4 (4.8-7.9) mU/L,Z=6.339] (both P＜0.05).In normal twins with or without discordant growth,the neonates with a lower birth weight had a higher TSH level [3.6(2.5-4.7) vs 2.4(1.8-2.9) mU/L,Z=0.962] in weight consistent group,compared with 6.0(4.4-7.8) vs 3.4(1.9-4.1) mU/L in weight inconsistent group (Z=4.369),both P＜0.05.Conclusions In the growth-discordant twins,neonates with a lower birth weight have a higher TSH level and a higher risk of temporary hypothyroidism.

Objective To analysis and summary the chromosome abnormal existing in old pregnant women from 2002 to 2013,and to provide basis for clinicians intervene the fetus with chromosome disorders.Methods The 4 539 pregnant women in Ningbo city from 2002 August to 2013 October accepted the fetal karyo type detection,were retrospective analyzed,the frequency of abnormal chromosomal karyotypes was calculated according to different age groups,and the pregnancy outcomes of the old pregnant women were followed up.Thechi-square testswere performed on the frequency dateof the abnormal chromosome karyotype,polymorphism,and serum screening of high risk for fetal chromosome detection of less than 35-years-old pregnant women.Results The total of advanced maternal age pregnancyduring the past 11 years in Ningbo City is 32 080,and the follow-up rate was 99.90％,there are 10 infants borned with chromosomal abnormalities,the 1 290 caseswere detected withadverse pregnancy.A total of 4 539 advanced maternal age pregnancyaccepted amniocentesis,in those we found 107 cases of chromosome abnormality fetus,116 cases of polymorphism.A total of 5 232 high-risk pregnant women accepted the serum screening in the same period (less than 35 years old),finding 135 cases of fetal chromosome abnormal and 69 cases of polymorphism.Conclusion To strengthen the prenatal diagnosis,especially for puerperae above the age of 39,will lower the birth rate of infants with chromosome disease and will be conducive to the high quality of population in Ningbo.

BACKGROUND:The magnetic resonance molecular imaging used in the research of lumbar disc degeneration includes T2 mapping and T1ρtechnologies at present.
OBJECTIVE:To evaluate the feasibility of 1.5 T MR equipment on T2 mapping of New Zealand white rabbits lumbar disc.
METHODS:T2 mapping images of New Zealand white rabbit lumbar discs were obtained on 1.5 T MR equipment. The regions of interest T2 values of lumbar discs were measured with post-processing workstation.
RESULTS AND CONCLUSION:Sagittal and coronal T2 maps of 3-month rabbit discs were obtained
satisfactorily on 1.5 T MR equipment. The regions of interest T2 values of nucleus pulposus in L 4/5 , L 5/6 and L 6/7 discs were (104.6±14.0) ms, (109.1±13.8) ms and (109.5±15.1) ms respectively at Pfirrmann
regions of interest T2 values of anterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (82.1±9.5) ms, (80.4± 11.2) ms and (79.9±10.6) ms respectively, and T2 values of posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (85.8±11.9) ms, (85.1±12.1) ms and (85.3±9.3) ms respectively. There were no significant differences in T2 values of nucleus pulposus, anterior annulus fibrosus and posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs at PfirrmannⅠP>g 0ra.0d5e).( However, the T2 values of nucleus pulposus were higher than those of annulus
fibrosus in the same discs (P<0.01), and there were no significant differences in T2 values between the anterior and posterior annulus fibrosus (P>0.05). The T2 values of rabbit lumbar discs obtained on 1.5 T MR equipment can be used for quantitative assessment of intervertebral disc signal.

Objective To investigate rational management for pregnant women with intermediate risk of Down syndrome (DS) through a retrospective analysis of second trimester maternal screening results for DS.Methods Second-trimester triple maternal serum screening for DS was performed.High risk ( ≥ 1/270) pregnant women received prenatal diagnosis.Intermediate (1/1000 to 1/270) and low (＜1/1000) risk pregnant women received routine obstetric examination.Data of ultrasound diagnosis,karyotype analysis of amniotic fluid and postpartum follow-up were collected.Outcomes of pregnant women were retrospectively analyzed.The incidences of DS among three groups were compared.Data of different groups were compared with Fisher exact or Chi-square test.Results Eighty-six thousand eight hundred and seventy-four pregnant women accepted maternal serum screening and outcomes of 86 126 cases were followed up,among which 4342 cases were DS high risk,8196 intermediate and 73 588 low risk.The incidence of DS was 6.22‰(27/4342) for high risk,0.73 ‰ (6/8196) for intermediate risk and 0.04 ‰ (3/73 588) for low risk group.The incidence of DS was higher in high risk group than in intermediate risk group (Fisher exact probability,P=0.000),and was higher in intermediate risk group than in low risk group (Fisher exact probability,P=0.000).Comparison among the three subgroups within intermediate risk group showed no significant differences (x2 =0.047,P =0.977).Conclusions Pregnant women with intermediate risk of DS should be paid more attention.Reasonable management such as ultrasound diagnosis and prenatal consultation should be provided.