Current Contents

2021 年 6 期目录
2021, 52(6): 1-6.
Abstract(88) HTML (35)
Abstract:
Forum on Children's Optometry and Visual Science and Young Adults' Eye Care
Abstract:
Based on the literature on myopia epidemiology, experiments of basic science, and clinical research, we have identified a number of major characteristics of the myopia problem. It was concluded that the student population of grades 1-12 showed high incidence of myopia and the problem was becoming increasingly more serious. Etiological investigations revealed the aggressive role played by environmental factors. Mature clinical correction methods were available, but there were still a multitude of uncertainties hampering the effort to slow the progression of myopia. Student myopia has become an issue of top concern in China's effort to prevent and control myopia. In order to approach the issue by dealing with problems in the educational environment and to explore for specific measures to prevent and control the onset and development of student myopia, it is important that we gain better understanding of the multiple effects on the onset and development of student myopia caused by the growing demand for education induced by high social development and the rapid changes in the educational environment caused by technological advancement. Approaching the problem from the perspective of the features of the eye and vision in the developmental stages of students of grades 1-12, and the study workload at each stage, this paper retrospectively reviewed the historical literature from the last 90 years and the data from cohort studies done before and after the outbreak of COVID-19. Identifying the education environment as the primary factor causing the onset and progression of student myopia, the paper fully recognizes the scientific rationality of and the specific role served byeducation-medicine synergy in student myopia prevention and control.
Abstract:
Epidemiological studies found that the incidence of myopia was increasing year by year and the age of onset of myopia was showing a trend of affecting increasingly younger children. Reducing the occurrence of myopia and controlling the increase of myopia diopter have always been the focus of research on the prevention and control of myopia. Large randomized controlled clinical trials have found that outdoor activities can effectively reduce the incidence of myopia and delay the progression of myopia. Basic experiments also revealed that there were certain connections between light exposure and myopia. We herein review the research progress, limitations and future directions of research on light exposure and myopia. From the perspective of light properties, increasing the intensity of light can slow the progression of myopia and reduce the occurrence of experimentally induced myopia. However, the actual mechanism of action is still unclear. The rhythmic changes of light exposure caused by the light/dark cycle may cause abnormalities in the secretion of melatonin and dopamine, and changes in the circadian rhythm of intraocular pressure and choroidal thickness, thus affecting myopia. The red light, with relatively longer wavelength and forming images behind the retina, tends to induce myopia more easily, while the blue light, with medium and short wavelength and forming images before the retina, tends to delay myopia progression. However, different species respond differently to lights of different wavelengths, and the relationship between light wavelength and myopia needs further investigation. Future research can be done to further explore the mechanism of action of how light exposure changes the progression of myopia, including the following aspects: how light changes dopamine levels, causing changes in downstream signal pathways, and thus controlling the growth of the axial length of the eye; how retinal photoreceptor cells receive light signals of different wavelengths in order to adjust the refractive power of the eyes; and how to design artificial lighting of reasonable intensity, composition and properties, and apply the design in myopia prevention and control.
Abstract:
The superior oblique muscle has the longest tendon among the six extraocular muscles and serves complex functions. Surgery on the superior oblique muscle is considered the most complicated and difficult procedure in the field of strabismus. This article focuses on the history of superior oblique muscle surgeries, including superior oblique weakening procedure and superior oblique strengthening procedure. We discussed the advantages, disadvantages, and indications of each type of surgery, providing colleagues in the field of ophthalmology with a comprehensive understanding of superior oblique muscle surgery and facilitating the carefully weighed decision to choose and perform the procedure.
Abstract:
Myopia is a process of ocular wall remodeling along with axial elongation after emmetropia decompensation, but the causal relationship among the changes taking place in ocular fundus structures during this process is not clear. The choroid, which lies between the retina and the sclera, plays an important role in the transmission of information related to myopia. The role of choroid in myopia is a hot research topic at present. Findings from animal experiments showed that form deprivation-induced changes in choroidal thickness may be related to the vascular perfusion, but the triggering mechanism of choroidal perfusion changes during the process of myopia still needs to to be further explored. Bruch’s membrane is an elastic membrane located in the front of the choroid with good contractile properties. In the process of myopia, regional changes of the synthesis or biomechanics of Bruch’s membrane may have formed the earliest structural basis of changes in choroidal thickness and blood flow. Taking choroidal thickness as a starting point, this paper focuses on the role and mechanism of Bruch’s membrane in the occurrence and development of myopia, which may further deepen our understanding of the mechanism of changes in choroidal thickness, and provide a theoretical basis for the development of new therapeutic targets for myopia.
Review
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Research and development of artificial biliary substitutes is an indispensable part of modern biliary surgery, bearing great clinical significance on the recovery of the normal functions of the biliary system. The implantation of artificial biliary substitutes may cause the blockage or stenosis of the biliary duct at the transplantation site, which is the most urgent problem in the research of artificial biliary substitutes. The fundamental cause of the problem is tissue hyperplasia caused by chronic inflammatory stimulation of artificial biliary substitutes. The regeneration of new bile duct tissue at the transplantation site can provide a solution to this problem. By looking at the literature from China and abroad, this paper reviewed the research and development of non-degradable artificial bile duct, degradable artificial bile duct and tissue-engineered artificial bile duct in order to provide reference for the further development of biliary replacements. Future studies should focus on the rapid formation of biliary epithelial layer on the tissue-engineered artificial biliary wall, the promotion of new biliary tissue formation, and the regulation of the degradation performance and mechanical properties of artificial biliary duct in order to fundamentally solve the problems encountered in the research of artificial biliary substitutes and accelerate the development of artificial biliary duct.
Abstract:
Chondrocytes have a limited supply of glucose and oxygen for metabolism since articular cartilages are relatively avascular. We herein reviewed the characteristics of chondrocyte glucose metabolism and the new research progress in chondrocyte glucose metabolism in the osteoarthritis process. Current research has shown that chondrocytes obtain glucose from synovial fluids and subchondral bones, take in glucose via specific glucose transporters, and metabolize glucose mainly through glycolysis and mitochondrial respiration to produce adenosine triphosphate (ATP). Glucose metabolism in chondrocytes is distinctive because it relies much more on glycolysis rather than mitochondrial respiration for ATP production, and shows Warburg effect and Crabtree effect. In osteoarthritic chondrocytes, the glucose metabolism disorder is presented as further suppression of mitochondrial respiration, over-active or impaired glycolysis, and decreased total production of ATP. However, the significance of the glucose supply for chondrocytes from synovial fluids and subchondral bones remains undefined. There are still disputes in the understanding of the changes in glycolytic pathways in osteoarthritic chondrocytes. Therefore, future research is needed to explore the characteristics of glucose metabolism in normal and osteoarthritic chondrocytes in order to develop new diagnostic and therapeutic strategies for osteoarthritis.
Abstract:
As a self-protective mechanism for cells to obtain energy by degrading their own structures or substances, autophagy widely occurs in basic physiological process of all kinds of eukaryotic cells. In recent years, studies have shown that autophagy can be induced through a variety of mechanical transduction pathways when various tissues and cells are exposed to different types of mechanical stress, and cells and tissues involved can thus regulate cell metabolic functions and participate in the pathological process of a variety of diseases. The stress receptors on the cell membrane and the multiple signaling pathways and cytoskeletons have been shown to play an important role in this process. At present, due to the difficulties in the establishment of the stress loading model and the limitations in the research methods concerned, the specific mechanical transduction mechanisms of autophagy induced by mechanical stress is not clear. Therefore, more reliable in vitro and in vivo models and more advanced research methodology are needed to investigate the mechanical transduction process of autophagy induced by mechanical stress, and to promote ultimately progress in the understanding of autophagy-related diseases and their treatments. This article reviewed the regulatory role of mechanical stress on autophagy in physiological and disease processes and the signal transduction process related to autophagy induced by mechanical stress.
Abstract:
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to ravage the world, posing great challenges to the public health system and threatening the health and survival of humans. The outbreak of COVID-19 leaves us with much to reflect on and calls on our attention to respiratory infectious diseases, especially new outbreaks of respiratory infectious diseases that are zoonotic. The importance of identifying viral pathogens should be highlighted because it is related to the prevention and treatment strategy of childhood pneumonia. Due to the highly infectious nature of COVID-19, the rapid mutation of the virus, and the lack of specific drugs, vaccines are currently the most effective means of prevention, and a global immune barrier must be established as soon as possible.
Medical Education
Abstract:
Oral Microbiology is a vital component of the basic science of stomatology and an important compulsory course for undergraduate students of stomatology, focusing on the oral microbiology and microecology, the pathogenesis of oral infectious diseases, and the relationship between oral microbes and human health. Our faculty team have made reforms of the theory and laboratory teaching of the course Oral Microbiology. We have introduced in the classroom the concept of Three Comprehensive Approaches to Education—the full involvement of everyone, the through-course approach and all-round education—and offered inquiry-based instruction through a combination of extracting the core information from every chapter, using the core information as the foundation, integrating the core information with clinical problems, and using experiment operation to foster in the students an attitude of solving clinical problems through research. These teaching innovations improved the undergraduate students’ motivation to learn. We evaluated the teaching effect with questionnaire surveys. The results suggested that the students showed high interest in learning and were satisfied with our teaching innovations. In addition, student performance evaluation for the course showed significant improvement, indicating that the instructional reform program of Oral Microbiology was conducive to students’ understanding and mastery of the course content, improved student motivation to learn and their grades, and received positive reviews from the students. We report herein, from three aspects, the course innovations and the experiences gained. We discussed the significance of integrating ideological and political theories teaching in all courses and using innovative teaching materials and teaching models and, highlighted their importance in the education of stomatology students, and proposed suggestions to further improve the course design of Oral Microbiology.
Abstract:
The cultivation of medical students’ research ability promotes in them high-quality career development. In addition to classroom instruction of the theoretical knowledge concerning research, the systematic training and practice of scientific research skills outside the classroom is also vitally important. We established the Volunteer Team of Gastric Cancer Surgery with the features of standardization, progressiveness, and practicality in order to cultivate the thinking skills concerning research and the research ability of medical students. Our team is supported by the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Taking clinical and basic research skills training as the focus of our work, we have organized systematic workshops focused on theoretical knowledge and research skills practice programs of divers forms. Our work helps improve the research ability of medical students, suggesting that research-oriented clubs play an active role in the cultivation of practical research ability of medical students and should be widely promoted.
Original Article
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  Objective   To study the effect of outer membrane vesicles (OMVs) derived from Salmonellatyphimurium (ST) on the ultrastructural features and immune function of dendritic cells (DC).   Methods   Mice bone marrow cells were collected aseptically, and myeloid DC were generated by the combined induction and amplification with recombinant mouse granulocyte-macrophage colony-stimulating factor (GM-CSF) and recombinant mouse interleukin-4 (rm IL-4). Cell morphology was observed under inverted phase contrast microscope and the phenotype was identified with flow cytometry. ST-OMVs were isolated through ultracentrifugation. The survival rate of DC was assessed with CCK-8 assay, and the stimulus concentration of OMVs was henceforth determined. The ultrastructural characteristics of DC loaded with OMVs were observed with transmission electron microscopy. The cytokine secretion, surface molecule expression and phagocytic capacity of DC were examined with flow cytometry.   Results   The DC induced and amplified in vitro displayed typical DC phenotype in morphological analysis and the purity of DC exceeded 85%. Transmission electron microscopy showed that there were large numbers of protrusions on the cell surface. After stimulation with ST-OMVs, it was observed that the dendritic structures on the surface of DC were reduced and a large number of phagolysosomes were found in the cytoplasm. In addition, increased numbers of mitochondria, swelling and typical apoptosis were observed. After treatment with ST-OMVs at 5 μg/mL and 10 μg/mL, the secretion of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) of DC increased significantly (P<0.05). Furthermore, the immature DC could differentiate into mature DCs after stimulation with ST-OMVs, which were characterized by a decrease in phagocytic capacity (P<0.05) and an upregulation of phenotypic markers (P<0.05).   Conclusion   ST-OMVs can stimulate DC to produce TNF-α and IL-1β and promote DC maturation and antigen presentation.
Abstract:
  Objective   To investigate the regulatory function and mechanism of β-hydroxybutyrate (β-OHB), a ketone body, on the mitochondrial oxidative stress of inflammatory human umbilical vein endothelial cells (HUVECs).   Methods   Lipopolysaccharide (LPS) and adenosine triphosphate (ATP) were used to induce macrophages to release proinflammatory factors, and the culture supernatant was collected as a macrophage-conditioned medium (MCM) to culture HUVECs. A total of 7 groups of cells were used in the study: ①control group, or normal cultured HUVECs; ②MCM group, or the MCM-cultured HUVECs; groups ③ to ⑦ were all HUVECs co-cultured with different reagents, including ③MCM+β-OHB group, ④MCM+N-acetylcysteine (NAC) group, ⑤MCM+β-OHB+NAC group, ⑥MCM+β-OHB+histone deacetylase agonist ITSA1 group, and ⑦MCM+β-OHB+histone deacetylase inhibitor Entinostat group. MitoSOX immunofluorescence staining was conducted to analyzes the mitochondrial superoxide levels, real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) was performed to examine the mRNA expression of antioxidant genes, and Seahorse mitochondrial energy analyzer was used to measure mitochondrial aerobic respiration capacity.   Results   Compared with the control group, mitochondrial superoxide production was significantly increased in the MCM cultured HUVECs cells, while β-OHB treatment significantly inhibited mitochondrial superoxide production, which was accompanied by an increase in the mRNA expression of antioxidant genes, and significant increase in the basal mitochondrial oxygen consumption rate and respiratory reserve capacity. NAC treatment did not further enhance the protective effect of β-OHB on mitochondrial functions. In addition, ITSA1 treatment could completely offset the antioxidant and mitochondrial protective effects of β-OHB, and these stated effects were still maintained after Entinostat treatment.   Conclusion   The ketone body β-OHB attenuates the mitochondrial oxidative stress of vascular endothelial cells through activating the antioxidant pathway and inhibiting histone deacetylase activity.
Abstract:
  Objective   To explore the effect of nuclear factor-erythroid 2-related factor (Nrf2) pathway activation on hippocampal neuron damage in neonatal rats with bilirubin encephalopathy.   Methods   Neonatal rats were randomly assigned to a control group (Control), a model group (Model) and an Nrf2 activator TBHQ (tert-Butylhydroquinone) group (TBHQ), with 20 rats in each group. Bilirubin solution was injected through the cerebellomedullary cistern to establish the neonatal rat model of bilirubin encephalopathy. Neurobehavioral changes were observed in rats and the water content of the brain tissue was measured. Nissl staining was done to observe the damage of hippocampal neurons. TUNEL staining was used to observe the apoptosis of hippocampal neurons. Colorimetric analysis was done to determine the Caspase-3 activity in the hippocampus. The content of malondialdehyde (MDA) and reduced glutathione (GSH) and the activity of superoxide dismutase (SOD) in the hippocampus were examined by chemical analysis. qRT-PCR and Western blot were done to measure the expression of Nrf2 and heme oxygenase-l (HO-1) mRNA and proteins in the hippocampus.   Results   After injection of bilirubin into the cerebellomedullary cistern, the young rats in the Model group and the TBHQ group showed different degrees of neurological abnormalities, while those in the control group showed no significant neurobehavioral abnormalities. Compared with the Control group, the Model group had severe neuronal damage, and the water content of brain tissue, the apoptosis of hippocampal neurons, the activity of Caspase-3 and the content of MDA content significantly increased (P<0.01), while the SOD activity, GSH content, the expression of Nrf2 and HO-1 mRNA and proteins significantly decreased (P<0.05). Compared with the Model group, neuronal damage was improved in the TBHQ group, and the water content of brain tissue, apoptosis of hippocampal neurons, activity of Caspase-3 and MDA content were all significantly reduced (P<0.01), while SOD activity, GSH content and the expression of Nrf2 and HO-1 mRNA and proteins were significantly increased (P<0.05).   Conclusion   Activation of the Nrf2 pathway can improve hippocampal neuronal damage in neonatal rats with bilirubin encephalopathy and inhibit neuronal apoptosis and the oxidation reaction.
Abstract:
  Objective   To identify the differences in the composition of gut microbiota of patients with post-stroke cognitive impairment (PSCI) in comparison with the normal cognition healthy controls (HC), and to study the potential association between gut microbiota and cognition function.   Methods   A total of 24 patients were recruited for the PSCI group, which was matched with 23 healthy subjects with no history of cardiovascular disease recruited over the same period for the control group. Fecal samples were collected for both groups, and Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive functions. The abundance, diversity and group difference of gut bacterial communities were determined with 16S rRNA gene sequencing, and the correlations between differences in bacterial species of the gut microbiota and cognitive function scores were examined with redundancy analysis (RDA)/canonical correspondence analysis (CCA).   Results   There was no significant difference in the general data or the alpha diversity of gut microbiota between the two groups (P>0.05). Inter-group comparison of microbial species composition revealed differences at the phylum and species levels, mainly represented as reduction in the relative abundance of Firmicutes and Bacteroidetes, and the relative enrichment of Proteobacteria. The relative abundance ofIntestinibacter bartlettii, uncultured bacterium Tyzzerella_3, Lactobacillus gasseri, and Fusicatenibacter saccharivorans of phylum Firmicutes in the PSCI patients were significantly reduced in comparison to that of the HC (LDA score>2), and these bacteria were positively correlated with MMSE and MoCA scores. In addition, theRuminococcus gnavus and Faecalimonas umbilicata of phylum Firmicutes and unculturedbacteriumPrevotellaceae_NK3B31 group of phylum Bacteroidetes were significantly enriched in comparison with those of the HC (LDA score>2), and these bacteria were negatively correlated with MMSE and MoCA scores. There were also correlations among these bacteria.   Conclusion   In this study, we observed compositional differences between the gut microbiota of PSCI patients and those of HC, and revealed that the differences were correlated, to some degree, to the cognitive functions, which will provide new perspectives for the clinical diagnosis and treatment of PSCI.
Abstract:
  Objective   To investigate the role of cisatracurium in diaphragm atrophy in mechanically ventilated (MV) rats and its possible mechanism.   Methods   30 adult male Sprague-Dawley (SD) rats were randomly assigned to 5 groups: Rats in the control (CON) group (n=6) were fasted for 30 h without any other intervention; rats in the MV group (n=6) were fasted for 6 h, and then mechanically ventilated for 24 h while receiving continuous infusion of sodium pentobarbital and 0.9% NaCl; rats in the MV+cisatracurium (MVC) group (n=6) were fasted for 6 h, and then mechanically ventilated for 24 h while receiving continuous infusion of sodium pentobarbital and cisatracurium; rats in the MV+chloroquine (QMV) group (n=6) and rats in the MV+cisatracurium+chloroquine (QMVC) group (n=6) received intraperitoneal injection of chloroquine (30 mg/kg), an autophagy inhibitor, at 24 h and 30 min prior to MV in addition to the treatments given to the MV group and the MVC group, respectively. The rats in each group were sacrificed 30 hours later, and costal diaphragm muscle specimens were collected. The cross-sectional area (CSA) of the diaphragm fibers was observed through HE staining, and the colocalizations of TOM20 and LC3 were assessed by immunofluorescence staining. The expression levels of PINK1, Parkin, P62 and LC3, the mitophagy-related proteins, and the expression levels of MAFbx and MURF-1, muscular-atrophy-related proteins, were evaluated by Western blot.   Results   Respective comparisons of the MV group with the CON group and the MVC group with the MV group showed that the CSA decreased (P<0.05), the expression of MURF-1, MAFbx, PINK1, Parkin and LC3Ⅱ/Ⅰproteins increased (P<0.05), the number of co-expressed mitochondria of TOM20 and LC3 and the expression of LC3 increased and the expression of P62 protein decreased (P<0.05) in the MV and MVC groups. Respective comparisons of the QMV group with the MV group and the QMVC group with the MVC group showed that the CSA increased (P<0.05), the expression of MURF-1, MAFbx, PINK1, Parkin and LC3Ⅱ/Ⅰ proteins increased (P<0.05), the number of co-expressed mitochondria of TOM20 and LC3 and the expression of LC3 decreased and the expression of P62 protein decreased (P<0.05) in the QMV and QMVC group.   Conclusion   Mechanical ventilation for 24 h caused diaphragm atrophy in SD rats. Cisatracurium may aggravate diaphragm atrophy in mechanically ventilated rats through the autophagy-lysosome (AL) pathway, a process that may be related to the PINK1/Parkin-mediated mitophagy, and chloroquine may reduce diaphragmatic atrophy induced by cisatracurium by blocking the AL pathway.
Abstract:
  Objective   To explore the health risks of the interactive effects between PM2.5 and ozone on cardiovascular mortality in Chengdu.   Methods   Daily data on the mortality of cardiovascular diseases, including data for both men and women, during 2014-2016 were collected. The meteorological data, the daily average of particulate matter with aerodynamic diameter less than 2.5 micrometers (PM2.5), and the daily ozone 8 h maximum concentration (O3 8-h max) in Chengdu of the same period were also collected. Generalized Additive Models (GAMs) were adopted to explore the respective adverse health effects of PM2.5 and O3 8-h max and the synergistic effects between PM2.5 and O3 8-h max on the mortality of cardiovascular diseases in the city.   Results   The highest health risks of PM2.5 and O3 8-h max for mortality of cardiovascular diseases were found to be the strongest for the cumulative effect of the lag of one day (lag01). For every 10 µg/m3 increment in the mass concentration of PM2.5 (lag01), the associated increase in risks for total, male, and female cardiovascular mortalities was 0.35%, 0.26% and 0.38%, respectively. For every 10 µg/m3 increment in the mass concentration of O3 8-h max (lag01), the associated increase in risks for total, male, and female cardiovascular mortalities was 0.66%, 0.43%, and 1.05%, respectively. The total, male, and female cardiovascular mortalities all reached their maximum values when high concentration of PM2.5 coexisted with high concentrations of O3 8-h max.   Conclusion   There was a synergistic amplification effect between high concentrations of PM2.5 and high concentrations of O3 8-h max on cardiovascular mortality.
Abstract:
  Objective   To study the relationship between oral disease and depressive symptoms in middle-aged and older adult populations in China.   Methods   The data from the China Health and Retirement Longitudinal Study (CHARLS) done between 2013 and 2015 were analyzed. A total of 3828 middle-aged and older adults showing no depressive symptoms in an assessment with the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) were selected as the subjects of observation, and oral disease was taken as the dependent variable. Changes in depressive symptoms in the population were tracked in 2015, and the Cox proportional hazards model was used to estimate the relationship between oral diseases and depressive symptoms.   Results   The detection rate of depressive symptoms was 29.3% in middle-aged and older adults with oral diseases, and that of middle-aged and older adults without oral diseases was 20.4%, the difference being statistically significant (P<0.001). After controlling for confounding factors, Cox proportional hazards model analysis found an association between oral diseases and depressive symptoms (hazard ratio [HR]=0.683, 95% confidence interval [CI]: 0.583-0.800). It was more likely for middle-aged and older women (HR=0.708, 95% CI: 0.573-0.874) with oral diseases to develop depressive symptoms than men (HR=0.644, 95% CI: 0.506-0.819) did (P<0.05).   Conclusion   Oral diseases in the middle-aged and older adult populations tended to lead to depressive symptoms, and women showed higher rate than men did. Prevention and control measures should be taken actively in the course of oral disease treatment to promote mental health of middle-aged and older adults.
Abstract:
  Objective   To analyze the impact of the social environment of a community on the self-rated health of middle-aged and older adults living in the community, and to provide a basis for building favorable community social environment that promotes the health of middle-aged and older adults.   Methods   Using the community and individual survey data from China Health and Retirement Longitudinal Study (CHARLS) done in 2011, 7822 middle-aged and older adults living in 397 communities were selected as the subjects of the study. Community social environment under study included community socioeconomic status, community social security and community services. Self-rated health was measured with a five-level score. A three-level hierarchical generalized linear model (HGLM) was used to analyze the impact of community social environment on the self-rated health of middle-aged and older adults.   Results   The proportion of subjects who reported self-rated poor health was 28.8%. According to the results of the three-level HGLM, the self-rated health of middle-aged and older adults showed differences at both the city and the community levels, and the variance reduction ratio reached 35.71% at the community level. The self-rated health status of residents in the communities with medium and high net per capita income was better than that in the communities with low net per capita income (OR=0.84, P<0.05;OR=0.70, P<0.05). The self-rated health status of residents in the communities with secondary and higher education levels was better than that in the communities with low education level (OR=0.78, P<0.05;OR=0.73, P<0.05). The self-rated health of middle-aged and older adults in the communities with unemployment subsidies was much better (OR=0.77, P<0.05). The self-rated health status of middle-aged and older adults with chronic diseases was worse (OR=4.46, P<0.05). Middle-aged and older adults living in cities had better self-rated health status (OR=0.67, P<0.05).   Conclusion   Community socioeconomic status and community unemployment subsidy are positively correlated with the self-rated health of middle-aged and older adults living in the community. It is necessary to pay special attention to the health status of middle-aged and older adults in communities of low socioeconomic status, improve unemployment insurance policies, and promote the health of middle-aged and older adults.
New Technology and Methods
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  Objective   To investigate the feasibility of low-dose CT scan of the temporal bone combined with reconstruction matrix size of 1 024×1 024 and the effect of the reconstruction matrix size on image quality.   Methods   Normal-dose and low-dose bilateral temporal bone CT scans were performed on twelve adult male cadaveric skull specimens using the 160-slice multi-detector CT scanning of United Imaging Healthcare. Normal-dose CT images were reconstructed with matrix sizes of 512×512 and 1 024×1 024, while low-dose CT images were reconstructed with the matrix size of 1 024×1 024. CT value, noise, signal-to-noise ratio, contrast-to-noise ratio, the visualization scoring of 15 anatomical structures of the temporal bone, and the result of three-dimensional reconstruction of the ossicular chain were compared among the three groups.   Results   The radiation dose of low-dose CT scanning was reduced by about 50% compared with that of normal-dose CT. There was no significant difference in CT values of air, soft tissues and bones among the three groups. Low-dose temporal bone CT with the matrix size of 1 024×1 024 had higher noise, but much better visualization of temporal bone structure than the normal-dose temporal bone CT with matrix size of 512×512. Both the three-dimensional reconstructions of normal-dose and low-dose 1 024×1 024 matrix images were satisfactory and showed no significant difference. The morphology, size and relative position of malleus, incus, stapes, cochlea, and labyrinth, as well as the location of the ossicular chain in the cranium were all clearly displayed.   Conclusion   Low-dose temporal bone CT with the matrix size of 1 024×1 024 can be used to effectively reduce the radiation dose and significantly improve the spatial resolution and the visualization of the temporal bone anatomical structures compared with the normal-dose temporal bone CT with a matrix size of 512×512.
Clinical Research
Abstract:
  Objective   To observe the possible changes in the integrity of the cornea and corneal endothelial cells of children/adolescents with low or moderate myopia after long-term wearing of orthokeratology (ortho-k) lenses, as well as the time when the relevant changes occur, so as to evaluate the safety of long-term wearing of ortho-k lens and to provide a reference for the safety evaluation of subjects wearing ortho-k lenses.   Methods   Subjects were recruited in the Contact Lens Clinic, West China Hospital, Sichuan University for a three-year prospective study. Ortho-k of the same brand was matched for the subjects. The central corneal thickness (CCT), corneal endothelial cell density (ECD), and hexagonal cell ratio (HEX) were measured prior to the wearing of ortho-k lenses and after wearing ortho-k lenses for 1 month, 3 months, 6 months, and every 3 months until 36 months. The results of corneal fluorescence staining were recorded during each follow-up. When corneal staining was observed, the Efron grading standard was used for grading and corresponding treatment was given.   Results   A total of 33 (66 eyes) myopic patients were included in the study. 15 cases (46.2%) reported having binocular foreign body sensations and tearing within the first week of wearing the lenses. After the subjects became adapted to wearing the lenses, the symptoms disappeared without intervention. During the follow-up period, 31 cases (93.94%) of binocular corneal staining were observed, of which, 24 cases (72.73%) were graded as G0, receiving no treatment, 5 cases (15.15%) were graded as GⅠ, and 2 cases (6.06%) were graded as GⅡ. Corresponding clinical treatment for corneal staining was given to the GⅠ and GⅡ subjects. This study found that the corneal ECD was inversely proportional to age (r=-0.380, P=0.002). During the three-year follow-up period, the subjects’ left eye ECD decreased from the baseline at 24 months and the right eye ECD decreased from the baseline at 27 months (P<0.05). The CCT results in the subjects showed that CCT became thinner at 1 month after wearing the lens (P<0.05), but the follow-up CCT showed a stable trend.   Conclusion   After three years of long-term follow-up, no serious corneal complications occurred in children/adolescents with moderate and low myopia after long-term wearing of ortho-k lens. The corneal ECD of both eyes started decreasing 24 months after wearing the ortho-k lenses and the CCT decreased 1 month after wearing the lenses.
Abstract:
  Objective   To study the surgical effects of medial rectus recession (MRR) on divergence insufficiency esotropia (DIE).   Methods   Nine DIE patients who were admitted to and had MRR at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University between December 2017 and June 2020 were included in this retrospective study. All patients were followed up for 1 year at least. The postoperative esodeviation, near-distant disparity (NDD) and visual function were observed and compared.   Results   The mean age of the 9 patients was 28.8 years old (10-49 yr.), including 3 adolescent patients (≤18 yr.). The mean preoperative esodeviation was (19.8±13.2) PD for near and (32.6±15.3) PD at distance, while, the mean postoperative esodeviation 1 year after MMR was (−0.2±3.5) PD for near and (6.0±2.2) PD at distance, showing significant improvement over the mean preoperative esodeviation (P=0.012, P=0.007). NDD dropped from (12.8±2.4) PD before the surgery to (6.0±2.2) PD 1 year after the surgery, showing significant improvement (P=0.008), and remained stable 1 year after the surgery (F=0.075, P=0.900). There was no significant improvement of near stereopsis (P=0.306). Binocular function at distance was significantly improved after surgery (Worth 4 dots test : P=0.017; Bagolini striated glasses: P=0.035). The patients were divided into two groups, the adolescent group (age≤18 yr., n=3) and the adult group (age>18 yr.,n=6). Prior to the operation, the mean spherical diopter of the adolescent group (OD −1.75 D, OS −1.92 D) was lower than that of the adult group (OD −6.17 D, OS −6.04 D) (P=0.012). The average value of preoperative AC/A of the adolescent group was 4.33. It was 2.33 in the adult group, which was lower than the normal value, and significantly lower than that of the adolescent group (P=0.12). There was no significant difference in esodeviation or NDD between the adolescent group and the adult group before and after operation.   Conclusions   Medial rectus muscle recession can effectively improve the NDD and the binocular function at distance of patients with divergence insufficiency esotropia. Postoperative esodeviations both for near and at distance tend to regress after the surgery. Therefore, it is recommended that the amount of MRR be increased in the treatment of DIE.
Abstract:
  Objective   To investigate the primary diseases and the distribution of the clinical characteristics of pediatric retinal detachment.   Methods   Clinical records of patients aged 0-14 years old who had retinal detachment and who were hospitalized at the Department of Ophthalmology, West China Hospital, Sichuan University between January 2015 and December 2020, were retrospectively analyzed. The information on the demographic data, history, the scope of retinal detachment, and prognosis was retrieved and documented.   Results   A total of 464 eyes of 393 patients were included in this study, including 261 male and 132 female patients at a ratio of 1.98:1. The most common type of primary disease causing pediatric retinal detachments was associated with ocular dysplasia (227 cases, 57.8%), followed by trauma (78 cases, 19.8%) and myopia (56 cases, 14.2%). For infants and preschool children, the primary disease was predominantly ocular dysplasia at a rate of 81.8% (126 cases) and 55.8% (43 cases), respectively. For school-age children, in addition to ocular dysplasia (58 cases, 35.8%), myopia (49 cases, 30.2%) and ocular trauma (43 cases, 26.5%) also accounted for a large proportion of the primary diseases. The most common type of pediatric retinal detachment was rhegmatogenous retinal detachment (184 cases, 46.8%), and ocular trauma and myopia were the most common primary diseases, accounting for 37.5% (69/184) and 30.4% (56/184), respectively. 170 patients were diagnosed with traction retinal detachment, the second most common type of pediatric retinal detachment, and familial exudative vitreoretinopathy (FEVER) was the main primary disease, accounting for 47.6% (81/170). Exudative retinal detachment (39 cases, 9.9%) was the least common type of pediatric retinal detachment. Coats disease was the main primary disease causing exudative retinal detachment, accounting for 71.8% (28/39). After the first repair surgery, patients who had complete traction retinal detachment generally had poorer anatomical outcomes compared with those with complete rhegmatogenous retinal detachments (|Z|=3.026, P=0.002). The retinal break was most commonly seen on the temporal side in pediatric rhegmatogenous retinal detachments. In the retinal detachments caused by trauma, the most common type of retinal break was retinal tear, followed by ora serrata dialysis. Myopic rhegmatogenous retinal detachments were most commonly found in the round holes in lattice degeneration region.   Conclusion   In the current study, boys were found to be more susceptible to retinal detachment than girls did. Ocular dysplasia, ocular trauma and myopia were major etiologic factors for pediatric retinal detachment. Appropriate information and education measures should be emphasized for different age groups.
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  Objective   To investigate the safety and medium- and long-term efficacy of surgical radiofrequency ablation to treat atrial fibrillation during concomitant mitral valve surgery.   Methods   From January 2014 to December 2018, 280 patients with mitral valve disease and the comorbidity of preoperative atrial fibrillation were recruited for the study. Among them, 130 patients received only mitral valve surgery (non-ablation group), and 150 patients were underwent surgical radiofrequency ablation for the atrial fibrillation during concomitant mitral valve surgery (ablation group). Among the 150 patients of the ablation group, 80 had biatrial ablation, and 70 had left atrial ablation. Under general anesthesia, median sternotomy was done on all patients and cardiopulmonary bypass was established through the ascending aorta and superior and inferior venae cavae. After aortic occlusion, patients in the ablation group underwent the ablation procedure with the Atricure® bipolar ablation device, using the Cox Maze Ⅲ procedure as a reference. In addition, the left atrial appendage was removed and electrocautery of the ligament of Marshall and Waterston’s groove were performed in all Cox Maze cases. Following ablation, mitral valve replacement or repair was performed. All patients were given 200 mg oral amiodarone on the first day after surgery, for three times/d×7 d, which was followed by twice/d×7 d, and then oral amiodarone 200 mg/d was maintained till the end of 3 months after surgery (ablation group) or 12 months after surgery (non-ablation group). Patients were followed up at the intervals of 3 months, 6 months, 12 months, 2 years, 3 years, and 5 years after discharge. The follow-up service included standard 12-lead chest electrocardiogram (ECG) and 24-h dynamic ECG. The primary end point of the study was the time point of postoperative atrial fibrillation and the secondary endpoints were major cardiovascular events, death, and readmission due to heart failure.   Results   The surgeries were successfully performed in all subjects of the study. A total of 30 patients were lost to follow-up within 5 years after operation (10.7% losses to follow-up), including 11 patients in the ablation group and 19 patients in the non-ablation group. The proportion of patients who did not have atrial fibrillation in the ablation group and the non-ablation group at 6 months, 12 months, 2 years, 3 years and 5 years after surgery was 83.3% and 27.7%, 72.7% and 20.8%, 66.0% and 15.4% 61.3% and 13.1%, and 43.3% and 10.8%, respectively, with the data from the two groups showing statistically significant difference (P<0.001). The proportion of patients who did not have atrial fibrillation in the biatrial ablation and the left atrial ablation group at 6 months, 12 months, 2 years, 3 years and 5 years after surgery was 87.3% and 87.5%, 92.4% and 82.8%, 90.5% and 85.7%, 94.8% and 88.1%, and 75.5% and 69.4%%, respectively, with the data from the two groups showing no statistically significant difference (P>0.05). However, the cumulative incidence of atrial fibrillation in the two groups showed statistically significant difference (P<0.001). There were no deaths within 30 days after operation in either group. There was no significant difference in cerebrovascular accident, readmission for heart failure, pulmonary infection and mediastinal infection between the two groups within one year after operation (P>0.05). However, the proportion of patients who had permanent pacemaker installed due to Ⅲ-degree atrioventricular block in the ablation group was higher than that in the non-ablation group (P<0.05). The proportion of patients who required re-drainage due to delayed pericardial effusion in the ablation group was higher than that in the non-ablation group (P<0.05).   Conclusion   In the group of patients who had modified Cox Maze procedure with bipolar ablation device to treat atrial fibrillation during concomitant mitral valve surgery, the maintenance rate of sinus rhythm after cardioversion was significantly higher than that in the non-ablation group. The surgery showed better safety and significantly better medium- and long-term outcomes. Left atrial ablation and biatrial ablation were both considered safe and effective surgical treatment for atrial fibrillation. Compared with the left atrial ablation group, the biatrial ablation group achieved better effects in restoring and maintaining sinus rhythm without an increase the incidence of perioperative complications.
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  Objective   To explore the factors affecting the adverse prognosis of elderly inpatients with gastrointestinal bleeding (GIB).   Methods   We retrospectively analyzed the clinical data of elderly patients aged 60 and over admitted with GIB to the Department of Gastroenterology, West China Hospital, Sichuan University between January 2016 and January 2021. The adverse outcome was defined as admission to the intensive care unit and/or in-hospital death during the patient’s stay at the hospital. Univariate and multivariate logistic regression analyses were done to identify the risk factors associated with the adverse outcome of the elderly.   Results   A total of 885 elderly patients (median age: 72.00 years, 517 males and 368 females) with GIB were enrolled, including 436 cases of upper GIB (UGIB) and 449 cases of lower GIB (LGIB). The overall rate of adverse outcome was 13.22% (117/885), which was significantly higher in the UGIB patients than that in the LGIB patients (P<0.001). Univariate logistic regression identified UGIB (P<0.001), shock index>1 (P<0.001), hemoglobin (P<0.001), blood urea nitrogen (P<0.001), creatinine (P<0.001), and international normalized ratio (INR) (P<0.001) on admission, as well as erythrocyte transfusion (P<0.001), fresh frozen plasma (FFP) transfusion (P<0.001), and platelet transfusion (P<0.001) were associated with adverse outcome. Multivariate logistic analysis showed that UGIB (P<0.001), shock index >1 on admission (P=0.001), higher INR on admission (P=0.015) and FFP transfusion during hospitalization (P<0.001) were independent risk factors for adverse outcome of elderly patients with GIB. Further analysis showed that INR>1.5 on admission significantly increased the risks of adverse outcome (P<0.001).   Conclusion   Elderly patients with UGIB exhibited worse prognosis than those with LGIB. After adjusting for age and the location of bleeding, shock index>1, INR>1.5 on admission and FFP transfusion were considered independent risk factors for the adverse outcome of elderly inpatients with GIB.
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  Objective   To investigate the risk factors of in-hospital mortality in patients with combined ischemic heart disease (IHD) and gastrointestinal bleeding (GIB).   Methods   Patients who were hospitalized and received treatment for IHD combined with GIB at West China Hospital, Sichuan University between Jan. 2015 and Jan. 2018 were included in the study. Information concerning their baseline data, comorbidities, history of anticoagulant and antiplatelet medication, laboratory data on admission, and in-hospital treatments was collected. In-hospital death of all causes was taken as the primary endpoint event of the study, and multivariate logistic regression analysis was conducted to identify the independent risk factors of mortality during their hospital stay for this specific type of patients. Then, receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was calculated accordingly.   Results   A total of 395 patients met the enrollment criteria and were included in the study. Among them, 342 patients were discharged after their condition improved, and 53 patients died during hospitalization. Analysis of the cause of death revealed that cardiogenic death was the leading cause of death (54.7%), which was followed by infection-caused death (24.5%). Logistic regression analysis revealed that patients with ST-segment elevation myocardial infarction (STEMI) had a 2.527-fold risk of mortality compared with patients with non-acute coronary syndrome (odds ratio [OR]=2.527, 95% confidence interval [CI]: 1.152-8.277, P=0.043), and patients with comorbidity of chronic renal disease (CKD) had a 2.89-fold risk of mortality (OR=2.89, 95%CI:1.187-7.037, P=0.019). It was also shown the higher level of WBC count (OR=1.123, 95%CI: 1.057-1.193, P<0.001) and lower hemoglobin (OR=1.014, 95%CI: 1.003-1.025, P=0.013) on admission were related to in-hospital mortality. On the other hand, endoscopy (OR=0.305, 95%CI: 0.103-0.881, P=0.029) was identified as a protective factor in hospital treatment that decreased the risk of in-hospital mortality. ROC curve was drawn by combining the aforementioned variables to predict in-hospital mortality, which had an AUC of 0.79.   Conclusion   The actual type of IHD being STEMI, the patient’s condition being complicated with chronic kidney disease, and having high white blood cells and low hemoglobin levels upon admission were considered independent risk factors for in-hospital death outcome of IHD patients complicated with GIB, while undergoing endoscopy during hospitalization was considered as a protective factor.
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A 46-year-old woman was admitted for repeated abdominal distention and constipation for more than 10 years and further deterioration for 5 years. Colonoscopy showed, in the sigmoid colon, nodular neoplasm protruding into the cavity, resulting in local intestinal stenosis, through which the endoscopy could not pass. Pathological findings of the biopsy sample revealed changes caused by intestinal endometriosis. The patient underwent multiple endoscopic dilatation treatments in our hospital and the interval between recurrences of intestinal stenosis was extended from 6 months to 4 years. Intestinal endometriosis can cause repeated intractable stenosis caused by the infiltration of ectopic glands in the intestinal wall, which usually requires surgical intervention. Herein, we report a case of severe intestinal stenosis caused by endometriosis in the sigmoid colon. Good results have been achieved through endoscopic dilatation treatment. This case suggests that endoscopic dilation has good application value in the treatment of this kind of disease, which needs further exploration and promotion.
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A 28-year-old female patient was referred to and admitted in our hospital for presence of anterior mediastinal mass for 4 years. Enchanced chest computed tomography (CT) revealed an anterior mediastinal mass of soft-tissue density measuring 7.1 cm×3.8 cm with slight homogeneous enhancement after intravenous administration of contrast agent. The mass was clinically considered a thymoma. Then, surgical excision of anterior mediastinal mass was performed under general anesthesia. Postoperative histopathology revealed that there were foamy histiocyte clusters on the background of fibrous tissue hyperplasia and hyaline, with lymphoid hyperplasia, infiltration of plasma cells, and the presence of emperipolesis of lymphocytes and plasma cells in the tissue cells. Immunohistochemistry showed S100 protein (+), cluster of differentiation (CD) 68 (+), CD163 (+), immunoglobulin G4 (+), and CD1a (−). Eventually, confirmed diagnosis of extranodal Rosai-Dorfman disease was made. The patient showed no clinical symptoms and no recurrence was found on CT images over the 3-year followup. In clinical practice, this disease should be differentiated from other anterior mediastinal masses such as thymoma, lymphoma, and teratoma.
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Subacute thyroiditis (SAT) is the most common self-limiting thyroid disease causing pain. The etiology of the disease remains unknown, but it is usually related to viral infection or allergic reaction after viral infection. SAT after vaccination is extremely rare. The patient had a fever of no clearly defined cause about 8 hours after receiving the first dose of a 0.5 mL 9-valent human papillomavirus vaccine (Gardasil 9). The highest temperature was 37.8 ℃, accompanied by a pain in the neck, fatigue and the increasing pain when swallowing. After the patient was admitted to the hospital, physical examination revealed Ⅱ° enlargement of the thyroid gland, which was hard and tender, and no vascular murmur was heard. There was no redness, swelling or ulceration at the vaccination site, and no obvious abnormalities were observed in other physical examinations. Laboratory findings were as follows: C-reactive protein, 25.20 mg/L; erythrocyte sedimentation rate, 55 mm/1 h; leukocyte, 4.94×109 L−1; thyrotropin, 0.137 mU/L; free thyroxine, 22.32 pmol/L; antithyroglobulin antibody, 69.18 IU/mL; anti-thyroid peroxidase antibody, 21.66 IU/mL. Thyroid ultrasonography showed diffuse enlargement of bilateral thyroid with uneven internal echo. The patient was diagnosed with SAT. After 5 days of treatment with ibuprofen, the patient no longer had low fever and the neck pain was relieved. The patient was followed up till now, and had completed the vaccination of the three-dose 9-valent human papillomavirus vaccine. The function of thyroid was found to be normal in follow-up visits, and SAT did not recur.
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2021 年总目录
2021, (6): 1050-1068.
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本刊征订启事
2021, 52(6): 1069-1069.
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