AIM:To explore the relationship between the amplitude of diurnal variations in the choroidal vascular index(CVI)and annual changes in spherical equivalent(SE)and axial length in school-aged children.METHODS: Prospective study. Totally 39 cases(39 eyes)of Chinese school-age children aged 7 to 12 that diagnosed as emmetropia and myopia and error of refraction at optometry clinics of Eye Hospital, Wenzhou Medical University from July to August 2021 were selected. While 33 cases(33 eyes)were finally included, with 6 cases of loss to 1 a follow-up. A total of 16 cases(16 eyes)with annual growth of SE<0.5 D and 17 cases(17 eyes)with annual growth of SE≥0.5 D were divided into a non-progression group and progression group, respectively. Swept-source optical coherence tomography(SS-OCT)and custom choroidal analysis software were used to longitudinally observe diurnal variations in CVI of subjects, and the association between CVI diurnal amplitude and annual changes in SE and axial length was analyzed.RESULTS:It showed no significant correlation between the CVI diurnal amplitude at 1 mm from the fovea and annual changes in SE of the non-progressive group(P=0.65), while in the progression group, the CVI diurnal amplitude at 1 mm from the fovea was negatively correlated with annual changes in SE(P=0.048). However, no significant correlation was identified between CVI diurnal amplitude and annual changes in axial length in either group(all P>0.05). The diurnal amplitude of the CVI at the 1 mm foveal center had an effect on annual SE progression(P=0.039). Conversely, the diurnal amplitude of axial length, the annual changes in axial length, and the maximum or minimum time of CVI demonstrated significant associations with SE progression(all P> 0.05).CONCLUSION: Diurnal variations in CVI amplitude are associated with SE progression in school-aged children, providing a basis for further understanding the choroid-related changes in the process of myopia onset and progression.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been reapproved for heart failure (HF) therapy in patients with and without diabetes. However, the initial glucose-lowering indication of SGLT2i has impeded their uses in cardiovascular clinical practice. A challenge of SGLT2i then becomes how to separate their anti-HF activity from glucose-lowering side-effect. To address this issue, we conducted structural repurposing of EMPA, a representative SGLT2 inhibitor, to strengthen anti-HF activity and reduce the SGLT2-inhibitory activity according to structural basis of inhibition of SGLT2. Compared to EMPA, the optimal derivative JX01, which was produced by methylation of C2-OH of the glucose ring, exhibited weaker SGLT2-inhibitory activity (IC₅₀ > 100 nmol/L), and lower glycosuria and glucose-lowering side-effect, better NHE1-inhibitory activity and cardioprotective effect in HF mice. Furthermore, JX01 showed good safety profiles in respect of single-dose/repeat-dose toxicity and hERG activity, and good pharmacokinetic properties in both mouse and rat species. Collectively, the present study provided a paradigm of drug repurposing to discover novel anti-HF drugs, and indirectly demonstrated that SGLT2-independent molecular mechanisms play an important role in cardioprotective effects of SGLT2 inhibitors.

To summarize the nursing experience of a post-operational patient with valvular heart disease and prolonged weaning due to tracheomalacia.Key points of nursing include real-time monitoring of bleeding and coagulation,dynamic implementation of anticoagulation programs;strengthening airway management,early warning and treatment of airway collapse;multi-dimensional joint diagnosis and treatment to speed up the rehabilitation process;real-time assessment,sequential management of sedation,analgesia and nutrition programs.After 27 days of careful treatment and nursing,the patient was weaned from a ventilator successfully and transferred to another department,and was discharged after 5 days.

Objective:To investigate the efficacy of Modified Banxia Xiexin Decoction on patients with functional dyspepsia (FD) and its impact on gastric function.Methods:From June 2021 to December 2022, at the Department of Gastroenterology, Wenzhou Central Hospital, a total of 56 patients with FD who met the diagnostic criteria of Rome Ⅳ were prospectively enrolled. The patients were treated with Modified Banxia Xiexin Decoction for 4 weeks. The clinical efficacy was evaluated by the upper gastrointestinal symptom severity index score. The gastric function was assessed by standard gastric loading test of liquid nutrient meal and standard gastric emptying test of solid meal. The total scores of dyspeptic symptoms, the maximal satiety threshold of proximal stomach, the initial satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were compared before and after the treatment. During the treatment and in 4-week follow-up after treatment, the adverse events (such as nausea, diarrhea, dizziness and rash) were observed. Wilcoxon rank sum test and paired sample t-test were used for statistical analysis. Results:After the treatment, 14 FD patients were cured, 22 patients showed significant improvement, 12 patients had response, and 8 patients showed no improvement. The total efficacy rate was 85.71%(48/56). The total score of dyspepsia symptoms after the treatment was lower than that before treatment (3.00(1.00, 4.00) vs. 13.00(8.00, 18.00)), and the difference was statistically significant ( Z=-7.96, P<0.001). After the treatment, the maximal satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were both higher than those before treatment ( (897.45±98.82) mL vs. (588.46±60.26) mL, (87.59±12.74)% vs. (36.59±15.95)%), and the differences were statistically significant ( t=19.98 and 18.70, both P<0.001). The initial satiety threshold of proximal stomach before and after treatment was compared((131.84±52.91) mL vs. (130.0±47.61) mL), and the difference was not statistically significant( P>0.05). No adverse events related to this study were observed during treatment period and in the 4-week follow-up. Conclusions:The Modified Banxia Xiexin Decoction can improve proximal gastric compliance and gastric emptying function in patients with FD. Additionally, it can alleviate dyspeptic symptoms and have good clinical efficacy and high safety.

Objective:To explore the application effect of the goal-oriented comprehensive teaching method in the rotation of breast surgery residents.Method:A total of 40 residents who rotated in the Department of Breast Surgery of Xiangya Hospital of Central South University from January 2019 to January 2020 were selected as the control group, and another 41 residents who rotated from February 2020 to February 2021 were selected as the study group. The control group adopted the traditional teaching method, while the study group adopted the goal-oriented comprehensive teaching method. The scores of theory and skill operation examination after teaching, nurses' clinical ability before and after teaching and satisfaction with teaching were compared between the two groups. SPSS 25.0 was used for independent sample t test, paired t test and chi-square test. Results:After teaching, the scores of theory and skill operation in the study group were significantly higher than those in the control group [(86.19±4.64) vs. (79.27±5.36), (89.32±5.47) vs. (84.51±6.22)], with statistical differences ( P<0.05). After teaching, the scores of clinical abilities of the two groups were higher than those before teaching ( P<0.05), and the scores of clinical abilities of the study group were higher than those in the control group, with statistical differences ( P<0.05). The satisfaction with teaching form, content, effect and comprehensive evaluation of the study group were higher than that of the control group, with statistical differences ( P<0.05). Conclusion:The application of the goal-oriented comprehensive teaching method in the teaching of rotation training of residents in the department of breast surgery can enhance their learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and improve the teaching quality, with high teaching satisfaction.

OBJECTIVE: To study the correlation of genome-wide distribution of 6-methyladenine (6mA) of DNA in chorionic tissues from abortuses with monosomy 21. METHODS: Genomic DNA was extracted from chorionic samples from four abortuses with monosomy 21 and four without. After quality and purity test, partial DNA was subjected to chromatin immunoprecipitation with anti-6mA antibody, and then identified by sequencing. The sequencing data was analyzed by using bioinformatic software for the difference in 6mA between the two groups. RESULTS: Analysis of read peaks suggested that the control group have much more 6mA genes (n=4607) compared with the experiment group (n=1059). For chromosome 21, this difference is even more pronounced (8032 vs. 1769). Above results suggested that the level of 6mA modification in monosomy 21 is low. Gene ontology enrichment analysis and KEGG pathway enrichment analysis indicated that the absence of 6mA genes in monosomy 21 is closely related to the growth and development of embryo. CONCLUSION The 6mA modification of human genes may play a similar role to 5-methylcytosine (5mC) modification during the growth and development of embryos.

Objective:To investigate the application value of baseline MRI multi-parametric imaging radiomics in prediction of neoadjuvant chemoradiotherapy (NCR) efficacy of rectal mucinous adenocarcinoma (RMAC).Methods:Retrospective analysis was performed in the Sixth Affiliated Hospital of Sun Yat-sen University from August 2012 to October 2018. A total of 79 patients were included in this study, including 52 males and 27 females, aged 20-78 years (median age 52 years). According to the classification criteria of pathological regression, all patients were divided into NCR responsiveness group ( n=31) and nonresponsiveness group ( n=48). And 701 imaging features of T 2WI, diffusion weighted imaging (DWI) and enhanced T 1WI images of baseline MRI were extracted, and feature subsets were selected by repeatability analysis and feature dimensionality reduction to construct the radiomics prediction model. The tumor features from baseline MRI between the NCR responsiveness group and the nonresponsiveness group were compared, and the features of P<0.05 were combined with the radiomics to construct a model. Using pathology as the gold standard, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of the prediction model, and the area under the curve (AUC), 95% confidence interval, sensitivity and specificity were calculated, and the DeLong test was used to compare the diagnostic efficacy of different prediction models. Results:By comparing the conventional tumor imaging characteristics of the NCR responsiveness group and the nonresponsiveness group, the differences in lymph node stage and mucinous nodule status between the two groups were statistically significant (χ2 =6.040, 5.870, P<0.05). The AUC of ROC curves based on T 2WI, DWI, and enhanced T 1WI radiomics were 0.816, 0.821, and 0.819, respectively, which were higher than those of conventional tumor characteristics (lymph node staging, mucinous nodule status) (AUC=0.607), and the differences were statistically significant ( Z=-2.391, -2.580 and -2.717, P<0.05). Among the joint prediction models of T 2WI, DWI and contrast-enhanced T 1WI radiomics and conventional tumor features, the DWI combined model had the largest AUC (0.843), and there was no statistically significant difference between the three combined models (all P>0.05). Conclusion:The baseline T 2WI, DWI, and contrast-enhanced T 1WI radiomics model can be used to predict the NCR efficacy of RMAC, which is better than the predictive efficacy of conventional features, and the combination with conventional features can further improve the predictive efficacy.

Objective: To investigate the clinicopathologic features and prognosis of the patients who had clear cell renal cell carcinoma (CCRCC) with metastasis to the pancreas. Methods: From Jan, 2000 to Dec, 2018, 18 patients with clear cell renal cell carcinoma (CCRCC) and had pathologically diagnosed metastasis to the pancreas were enrolled at Peking Union Medical College Hospital. The clinical and pathological data were retrospectively analyzed. Results: 11 out of 18 patients were male, and the other 7 were female. The average age of onset of CCRCC was 51.4 years. 8 cases (44.4%) occurred in the left kidney, and the other 10 cases (55.6%) with right kidney tumor. Three patients had synchronous pancreatic metastasis, and the other 15 patients had metachronous pancreatic metastasis. The median time from CCRCC onset to pancreas metastasis was 156 months. The main complaints of pancreas metastasis were abdominal pain, jaundice, gastrointestinal bleeding, nausea, weakness, loss of weight and so on. Seven patients (38.9%) had single lesion of pancreas, while 11 patients (66.1%) had multiple lesions of pancreas. Nine patients (50%) had other organs metastasis besides pancreatic metastasis at the same time. Five patients underwent pancreatic metastasis resection, while 15 patients received oral tyrosine kinase inhibitor(TKI). The mean follow-up was 171.7 months(1~361.5 months) and 5 patients died. The median overall survival (mOS) was 122 months, and the 5 year-survival rate was 81.4%. In univariate analysis, synchronous metastasis to the pancreas, relapse after 10 years, Memorial Sloan Kettering Cancer Center prognostic index, International Metastatic Renal Cell Carcinoma Database Consortium index were all significant parameters for patients′survival. Conclusions Metastasis to the pancreas from clear cell renal cell carcinoma were rare. These patients had better survival outcomes, especially those relapsing after ten years. Pancreatic metastasis resection had no significant benefit on patient′s survival.

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial ow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.
Aged ; Betacoronavirus ; isolation & purification ; Cannula ; Coronavirus Infections ; therapy ; Humans ; Oxygen ; administration & dosage ; Pandemics ; Pneumonia, Viral ; therapy