Numerical Simulation of In-Plane Crack Propagation in Aortic Dissection / 医用生物力学

Objective Based on interface damage, a numerical simulation method for in-plane propagation of false lumen (FL) was proposed to explore the regular pattern of in-plane propagation of the initial cavity. Methods Three interface damage modes were characterized by bi-linear traction separation law, and the damage parameters were calibrated by simulating peeling and shearing tests. The damage interface was introduced into the ideal double-layer cylindrical tube aortic model by means of cohesive zone model (CZM) to simulate the in-plane propagation of FL. The control variable method was used to establish several computational models to investigate the influence of cavity geometric parameters on propagation direction, critical pressure and interface damage mode. Results The interface damage was mainly opening mode (Mode I) in axial propagation and sliding mode (Mode II) in circumferential propagation. With radial depth of the initial cavity increasing, the propagation of the FL changed from circumferential direction to axial direction, the critical pressure decreased, and the axial damage tended to be pure opening mode. With circumferential angle and axial length of the initial cavity increasing, the critical pressure decreased and the circumferential damage tended to be pure sliding mode. The critical pressure of single damage was lower than that of mixed damage. Conclusions The CZM can effectively characterize interface damage behavior of elastic lamellae within the media, and it applies to numerical simulation of in-plane propagation of the FL. The results of this study is helpful to understand the complex pathophysiological process of dissection crack propagation.

Research Progress in the Efficacy and Safety of ALK Inhibitors in the Treatment of NSCLC Brain Metastasis / 中国肺癌杂志

Lung cancer is one of the most lethal malignancies in the world, with non-small cell lung cancer (NSCLC) accounting for approximately 80%-85% of all pathological types. Approximately 30%-55% of NSCLC patients develop brain metastases. It has been reported that 5%-6% of patients with brain metastases harbor anaplastic lymphoma kinase (ALK) fusion. ALK-positive NSCLC patients have shown significant therapeutic benefits after treatment with ALK inhibitors. Over the past decade, ALK inhibitors have rapidly evolved and now exist in three generations: first-generation drugs such as Crizotinib; second-generation drugs including Alectinib, Brigatinib, Ceritinib, and Ensartinib; and third-generation drugs like Lorlatinib. These drugs have exhibited varying efficacy in treating brain metastases in ALK-positive NSCLC patients. However, the numerous options available for ALK inhibition present a challenge for clinical decision-making. Therefore, this review aims to provide clinical guidance by summarizing the efficacy and safety of ALK inhibitors in treating NSCLC brain metastases.
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Clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars / 中华烧伤杂志

Objective: To explore the clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars. Methods: A retrospectively observational study was conducted. From January to June 2021, 60 patients with grade 3 and 4 post-acne atrophic scars who met the inclusion criteria were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine. According to the adopted treatment methods, 30 patients treated with fractional carbon dioxide laser combined with minimally invasive scar release were included in combined treatment group (19 males and 11 females, aged (26±4) years), and 30 patients treated with fractional carbon dioxide laser alone were included in laser alone group (18 males and 12 females, aged (25±6) years). All the patients received the treatment once every two months, totally 3 times. Before the first treatment and 2 months after the last treatment, the scars were assessed by échelle d'évaluation clinique des cicatrices d'acné (ECCA). In 2 months after the last treatment, the curative effect was evaluated and the total effective rate was calculated according to the ECCA score. The adverse reactions of patients during the treatment were recorded. Data were statistically analyzed with independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results: Before the first treatment, the ECCA scores of patients in the two groups were similar (P>0.05). In 2 months after the last treatment, the ECCA scores of patients in combined treatment group were significantly lower than those of laser alone group (Z=-2.89, P<0.05). The ECCA scores of patients in combined treatment group and laser alone group in 2 months after the last treatment were both significantly lower than those before the first treatment (with Z values of -4.81 and -4.79, respectively, P<0.05). In 2 months after the last treatment, the treatment in laser alone group cured the scars in 2 patients, and were markedly effective in 13 patients, effective in 7 patients, and ineffective in 8 patients; the treatment in combined treatment group cured the scars in 4 patients, and were markedly effective in 22 patients, effective in 3 patients, and ineffective in one patients. The total effective rate of scar treatment in combined treatment group (96.67%, 29/30) was significantly higher than 73.33% (22/30) in laser alone group (P<0.05). During treatment, in combined treatment group, 3 patients had pain, one patient had redness and swelling, and one patient had pigmentation. In laser alone group, one patient had pain, and 2 patients had pigmentation. No infection occurred in the wounds of all the patients in the two groups. Conclusions: Compared with fractional carbon dioxide laser alone, fractional carbon dioxide laser combined with minimally invasive scar release for post-acne atrophic scars can result in a higher total effective rate, with simple operation and good effect, so it is worthy of clinical application.

Role and potential significance of peroxisome proliferator-activated receptors in liver diseases / 临床肝胆病杂志

Peroxisome proliferator-activated receptors (PPAR) are members of the nuclear estrogen receptor family, and they are involved in a variety of physiological and pathological processes in the human body and play important roles in cellular metabolism, inflammation, and cancer. At present, there are three known subtypes of PPAR, i.e., α, β/δ, and γ. Studies have shown that PPARs are highly expressed in the liver and are widely involved in various physiological and pathological activities such as liver energy metabolism, oxidative stress, and inflammation, and they are also closely associated with the progression of liver diseases. This article reviews the role of PPAR in common liver diseases such as viral hepatitis, metabolic associated fatty liver disease, cholestatic liver disease, liver fibrosis, and primary liver cancer, and the current status of their application in the treatment of liver diseases.

Research progress on antibacterial peptides Epinecidin-1 / 药学实践杂志

The antimicrobial peptide Epinecidin-1 is a kind of small molecule active peptides extracted from Epinephelus coioides，which serves as the first line of defense for innate immune defense system of Epinephelus coioides against various pathogens. In vitro and in vivo studies have confirmed that the antimicrobial peptide Epinecidin-1 not only exhibits broad-spectrum anti-pathogen activities (including bacteria, fungi, viruses, and parasites, etc.), but also has pharmacological activities such as immune regulation, anti-cancer and wound healing. In this paper, the relevant research on the antimicrobial peptide Epinecidin-1 in recent years were summarized, including its mechanism of action, pharmacological activities, potential limitations and application prospects , so as to provide information for further research.

Inhibitory effects of gemcitabine hydrochloride combined with ferroptosis inducers on the proliferation of PANC-1 cells / 药学实践杂志

Objective To study the effects of three ferroptosis inducers Erastin (Era), sulfasalazine (SASP) and artesunate (Art) alone or combined with gemcitabine hydrochloride (hcGEM) on the proliferation inhibition of Human pancreatic cell line PANC -1. Methods The CCK-8 method was used to detect the inhibitory effects of different concentrations of Era, SASP and Art alone or combined with hcGEM on the proliferation of PANC-1, and the combination index (CI) was used to judge whether three ferroptosis inducers combined with hcGEM had synergistic inhibitory effect on PANC-1. Results The three ferroptosis inducers and hcGEM alone or in combination could significantly inhibit the activity of PANC-1. The inhibitory effects were enhanced with the concentration increasing. The CI values of hcGEM-Era 4∶1 or 1∶4 combination group and hcGEM-SASP 1∶400 combination group were less than 1.The CI values of hcGEM-Art 1∶4 or 1∶16 combination group were less than 1 only within a certain concentration range. Conclusion The inhibitory effects of the three ferroptosis inducers and hcGEM alone or in combination were dose-dependent. The combination of hcGEM and three ferroptosis inducers could synergistically inhibit the proliferation of PANC-1.

Effects of small leucine-rich proteoglycans on corneal transparency / 中华实验眼科杂志

Small leucine-rich proteoglycans (SLRPs) are necessary structural ingredients of the cornea, which are vital for the establishment and maintenance of corneal transparency.SLRPs are mainly located in the corneal stroma and can be divided into class Ⅰ, class Ⅱ, and class Ⅲ.The compensatory and cooperative interactions among SLRPs regulate the formation and assembly of stromal collagen fibrils, thereby maintaining the highly ordered arrangement of collagen fibrils, and establishing corneal transparency.Decorin and lumican are the main functional components of class Ⅰ and class Ⅱ SLRPs, respectively, and changes in their expression or abnormities in the structure of their core proteins affect the natural content and arrangement of other stromal extracellular matrix components, ultimately resulting in abnormal fibril formation, assembly, and arrangement, causing corneal opacity.SLRPs can regulate corneal wound healing and stromal matrix remodeling via binding to fibrotic molecules and their receptors, which provides bases for corneal diseases therapy and study of molecular mechanisms of corneal transparency.The bioactivities and the role of SLRPs in corneal transparency were reviewed in this article.

A Prototype of a Stereoacuity Test Using a Head-Mounted Display

Purpose@#To evaluate the test-retest reliability of a contour-based stereoacuity test using a head-mounted display (HMD) and compare it with other stereotests. @*Methods@#Thirty-two healthy adults aged 23-47 years were recruited from a tertiary hospital between August 2017 and July 2018. Two separate contour-based circles (crossed disparity: 135-1,350 arcsecs) were generated on a high-resolution phone display (Galaxy S7; Samsung, Seoul, Korea) using an HMD (Galaxy Gear VR). Two images were independently projected to each eye as graded circles with a random dot background. The results of the new HMD stereotest were compared to those of the standard Randot and TNO stereotests. The test-retest reliability was assessed using the Bland-Altman plot and Cohen’s kappa statistics. @*Results@#Among the 32 study participants, 17 (53%) were males and the mean age was 30.1 ± 4.8 years (range: 23-47). The mean stereoacuity was 160.3 ± 53.5 arcsecs in the first HMD stereotest (HMD1), 28.4 ± 12.5 arcsecs in the Randot stereotest, 96.1 ± 83.5 arcsecs in the TNO stereotest, and 143.3 ± 47.7 arcsecs in the second HMD stereotest (HMD2). The Bland-Altman plot showed a mean difference of 0.042 (-0.189 to +0.272, 95% limits of agreement) between HMD1 and HMD2. The reliability analysis showed an intraclass correlation coefficient of 0.499 (p = 0.022) and agreement of 81.25% in Cohen’s kappa statistics (Cohen’s kappa index = 0.119, p = 0.017). @*Conclusions@#The HMD stereotest without monocular cues showed fair test-retest reliability and reproducibility. Further studies using a high resolution display are needed to confirm the validity of the HMD stereotest.

Effectiveness of Inferior Oblique Myectomy in Unilateral Superior Oblique Palsy Depending on Magnitude of Hyperdeviation

Purpose@#To evaluate surgical outcome and effectiveness of inferior oblique (IO) myectomy on unilateral superior oblique palsy (SOP) as a primary treatment. @*Methods@#This study is a retrospective review of the medical records of 99 patients who had undergone IO myectomy due to SOP as a first-line treatment. Sixty-five patients with hyperdeviation of 15 prism diopters (PD) or less were categorized into group 1, 22 patients with hyperdeviation between 16 PD to 20 PD into group 2, and 12 patients with hyperdeviation higher than 20 PD into group 3. Preoperative hyperdeviation, postoperative hyperdeviation, and improvement of head tilting were then compared between the 3 groups. Surgery was determined to be successful when the post-op residual hyperdeviation is less than 5 PD, or when the improvement of hyperdeviation and head tilting was noted, for the patients who had preoperative deviation less than 5 PD, and without hypercorrection. @*Results@#All groups showed significant improvement of hyperdeviation, and the amount of correction was larger in group with larger preoperative hyperdeviation. 80.3%, 95.0%, and 90.9% of patients showed improvement of head tiling and success rate was 87.7%, 77.3%, and 50.0% in group 1, 2, and 3 respectively. Group 1 and 2, group 2 and 3 had no significant difference in success rate but only group 1 and 3 had significant difference. @*Conclusions@#Considering success rate with improvement of head position, self-titrating and possibility of overcorrection, IO myectomy could be an effective option as a first-line surgical treatment for unilateral SOP with hyperdeviation of 20 PD or less. However, due to a 50% success rate in patients with hyperdeviation larger than 20 PD, a secondary operation must be considered following IO myectomy, or a two-muscle procedure must be considered as a primary treatment.

Accuracy of the Hand-held Wavefront Aberrometer in Measurement of Refractive Error

Purpose@#To compare refractive error measured by hand-held wavefront aberrometers with postcycloplegic autorefraction (AR) and cycloplegic refraction (CR). @*Methods@#The medical records of patients who received refractive measurements using the wavefront aberrometer, postcycloplegic AR, and CR between January 2014 and January 2016 were retrospectively analyzed. The mean differences, 95% confidence intervals, and limits of agreement (LOA) were calculated for the refractive vector components (M, J0, and J45). @*Results@#Fifty-one patients (9.0 ± 5.5 years, male 41.2%) were enrolled in this study, and only the right eye of each was included. Refractive errors ranged from -9.25 to +7.25 diopters (D) for spherical equivalent (median, 0.75 D). The M component was not significantly different among the three methods (p = 0.080). However, the J0 vector component was significantly different (p < 0.001). After post hoc analysis, the wavefront aberrometer obtained more positive values for J0 compared to the other methods. The J45 component was not significantly different among the three methods (p = 0.143). The mean difference between the wavefront aberrometer and postcycloplegic AR was -0.115 D (LOA, -1.578 to 1.348 D) for M, 0.239 D (LOA, -0.371 to 0.850 D) for J0, and -0.015 D (LOA, -0.768 to 0.738 D) for J45. The mean difference between the wavefront aberrometer and CR was -0.220 D (LOA, -1.790 to 1.350 D) for M, 0.300 D (LOA, -0.526 to 1.127 D) for J0, and -0.079 D (-0.662 to 0.504 D) for J45. @*Conclusions@#The wavefront aberrometer showed good agreement with postcycloplegic AR and CR in spherical equivalents, but tended to produce slightly myopic results. The wavefront aberrometer also overestimated with-the-rule astigmatism. Therefore, we recommend that the device be used for estimations of refractive error, which may be useful for patients who have postural difficulties, live in undeveloped countries, or are bedridden.

Superior Oblique Atrophy on Magnetic Resonance Imaging with Clinical Features in Unilateral Superior Oblique Palsy

Purpose@#To investigate the correlation of superior oblique (SO) atrophy of magnetic resonance imaging (MRI) with clinical features including surgical success in unilateral SO palsy. @*Methods@#This study was a retrospective review of the records of 38 patients who had undergone inferior oblique (IO) myectomy due to SO palsy between January 2017 and March 2019 at our hospital. The patients with more than a 40% decrease of cross-section areas using preoperative orbital MRI were categorized into the atrophic group (16 patients). We compared surgical outcomes between the atrophic and non-atrophic groups. @*Results@#Preoperative IO over-action and vertical deviation showed no significant difference, but the excyclotorsion in paralytic eyes were more frequent in the atrophic group and the surgical success (62.5% vs. 95.5%), and the degree in improvement of vertical deviation (7.17 ± 5.19 prism diopters [PD] vs. 11.05 ± 5.59 PD) was significantly lower in the atrophic group. The degree of SO atrophy showed a weak correlation with the degree of improvement of hypertropia or diopter differences of bilateral head tilting. @*Conclusions@#SO atrophy, detected using preoperative MRI of unilateral SO palsy patients did not show a definite correlation with clinical features except for excyclotorsion in paralytic eyes but did show a clinically significant correlation with surgical outcomes. Preoperative MRI can therefore be used for predicting surgical outcomes of IO myectomy in unilateral SO palsy patients.

Relationship between the intake of salt and salted food and the infection of Helicobacter pylori in 40-69 years old local residents in a county with high gastric cancer risk in Anhui Province / 中华疾病控制杂志

Objective The aim of the present study was to investigate the relationship between the intake of salt and salted food and the infection of Helicobacter pylori (Hp) among 40-69 years old local residents in a county with high gastric cancer risk in Anhui province. Methods From July 2015 to August 2018, we conducted a questionnaire and a serological test for Hp among 40-69 years old local residents in Lujiang county, Anhui province. The questionnaire focused on the consumptions of salt and salted food. The relationship between Hp infection and risk factors was analyzed by gender. Univariate and multivariate logistic regression analysis were used to analyze the relevant influencing factors. Results The Hp infection rate of total local residents was 50.07%. Among male subjects, age, body mass index(BMI), marital status, educational level, job, labor intensity and income had no link to Hp infection (all P>0.05). But among female subjects, BMI was associated with Hp infection ( 2=13.454,P=0.001). Besides, alcohol consumption was a risk factor for Hp infection in male subjects(OR=1.789，95% CI:1.188-2.694，P=0.003). But, high intake of salt and salted food had no effect on Hp infection after adjustment for alcohol consumption variable in men using multivariate analysis (all P>0.05). After adjusted for BMI variable among female individuals, high salt intake (≥9 g/day) (OR=1.462，95% CI:1.060-2.015，P=0.021) and the high salted food intake (≥1 times /day) were risk factors for Hp infection in women(OR=1.560，95% CI:1.021-2.383，P=0.040). Conclusions In one county with high gastric cancer risk in Anhui province, high salt intake (≥9 g/day) and high salted food intake (≥1 times/day) are risk factors for Hp infection among 40-69 years old female local residents.

Clinical value of glycated hemoglobin combined with brain natriuretic peptide in predicting the prognosis of elderly hospitalized patients with acute myocardial infarction / 中华老年医学杂志

Objective:To investigate the relationship of glycated hemoglobin(HbA1c)and brain natriuretic peptide(BNP)levels with clinical prognosis of acute myocardial infarction.Methods:A total of 108 patients with acute myocardial infarction combined with diabetes mellitus, who underwent percutaneous coronary intervention(PCI)from March 2016 to June 2017 in our hospital, were enrolled.According to the HbA1c level, patients were divided into three groups: Group A(HbA1c≤6.9%, n=36), Group B(7%≤HbA1c≤7.9%, n=31)and Group C(HbA1c≥8%, n=41). HbA1c and NT-proBNP levels, cardiac function classification at admission and discharge, the incidence of adverse cardiac events during hospitalization and left ventricular ejection fraction(LVEF)at admission, discharge and 3 months after discharge were analyzed.Results:Among the three groups, plasma NT-proBNP levels were higher in Group C than in Group B and Group A( P<0.05), and there was no significant difference between Group B and Group C( P<0.05). Furthermore, HbA1c levels were positively correlated with NT-proBNP levels in Group C( P<0.05). Cardiac function grading was better in Group A and Group B than in Group C at discharge.During hospitalization, the incidence of adverse cardiac events in Group C was 29.3%, which was higher than in Group A(8.3%)and Group B(9.7%)( P<0.05). LVEF levels were significantly improved in Group A and Group B at discharge and 3 months after discharge, compared with those at admission, while Group C had no significant improvement in LVEF levels and had lower LVEF than Group A and Group B( P<0.05). Conclusions:HbA1c and NT proBNP levels can be used as a joint monitoring indicator in patients with acute myocardial infarctions after PCI, to help prevent and reduce the incidence of complications and mortality in patients with acute myocardial infarction after PCI and improve clinical prognosis.

Prospects of Application of Microbial Biofilm to Estimate PMI of Corpses in Water / 法医学杂志

In forensic pathology, the estimation of postmortem interval （PMI） has always been a difficult issue, and there is still lack of effective methods to estimate PMI of corpses in water. Microbial biofilm refers to the microbial population attached to non-biological or biological surfaces by microorganisms during microbial growth, that has a three-dimensional structure, surrounded by extracellular polymers and matrix networks created by itself. A series of community succession phenomena of microorganisms occur during the occurrence and development of microbial population. The microbial community and its succession process of this kind of biofilm attached to the surface of a corpse in water may become a new basis for estimation of the PMI of corpses in water. This review elucidates on the concept, classification, research methods, and influencing factors of biofilm and analyzes its application prospects in PMI estimation of corpses in water, which would provide new ideas for the researches in this field.

Regulation of angiotensin Ⅱ type 2 receptor in mechanically ventilated lung injury / 中华急诊医学杂志

Objective@#Through the study of angiotensinⅡ- type 2 receptor agonist (AT2R) after pretreatment of mechanical ventilation lung injury (VILI) in rats model, to clarify the role of angiotensin Ⅱ - type 2 receptor agonist (C21) in alleviating VILI inflammation and the damage of immune function and its possible mechanism.@*Methods@#In this experiment, the acute lung injury model was established by mechanical spring-volume ventilation in SD rats, and C21 pretreatment was performed to observe the pathological condition of lung tissue in rats with different ventilation duration, and to detect the inflammatory changes of BALF lavage fluid. Flow cytometry was used to detect the CD68+/iNOS+ labeled M1 type AMφ and the CD68+/Arg-1+ labeled M2 type AMφ in alveolar lavage fluid.@*Results@#The mechanical VILI rat model was successfully established. The pathological injury score of the mechanical ventilation 4 h model, the wet/dry weight of lung tissue, the number of cells and protein in BALF lavage fluid were increased significantly, the levels of TNF-α and IL - 1 were increased significantly, the levels of IL-4 and IL-10 were decreased significantly, and the level of inflammatory reaction decreased with the increase of ventilation time. The M1/M2 ratio in the 4 h ventilation model group was the highest, which was significantly different from the control group (P<0.05). Compared to the model group, the C21 pretreatment significantly reduced the levels of proinflammatory factors TNF-αand IL-1, and increased the levels of anti-inflammatory factors IL-4 and IL-10 in BALF (P<0.01). After the intervention of AT2R agonist at 4 h, 6 h and 8 h, the M1/M2 ratio of the model was lower than that of the model without AT2R agonist at 4 h, 6 h and 8 h.@*Conclusion@#Mechanical ventilation for 4 h in SD rats can establish a mechanical ventilation lung injury model. AT2R agonist C21 can promote the polarization of macrophages to m2-type, and C21 pretreatment may alleviate VILI inflammation and immune damage by altering the polarization of macrophages.

Association of vitamin D and risk of hypertension in Henan rural population / 中华疾病控制杂志

Objective The purpose of this study was to investigate the prevalence of vitamin D deficiency and hypertension in Henan rural residents, and to explore the association between vitamin D and risk of hypertension. Methods 2 013 Henan rural participants aged 18-80 years were recruited from a cross-sectional study. Logistic regression models and restricted cubic spline model were used to evaluate odds ratios (OR), 95% confidence intervals (95% CI) and dose-response relationship between vitamin D and risk of hypertension. Results In total population, the prevalence of hypertension was 40.34% (30.64% after age-standard), and the mean serum 25-(OH)D was (24.50 ± 16.18) ng/ml, and 53.95% of all participants were presenting vitamin D deficiency. Compared with non-hypertension, a lower level of serum 25-(OH)D was observed in people with hypertension. The prevalence of hypertension was 45.21% in vitamin D deficient group which was higher than in the vitamin D sufficient group (31.07%). Compared with the vitamin D sufficient group, the risk of hypertension was increase in the vitamin D deficient group (OR=1.59, 95% CI: 1.21-2.10), and the risk of hypertension decreased by 14% for every 10 ng/ml increase in serum 25-(OH) D levels. Moreover, an L-shaped relationship was observed between 25-(OH)D concentration and risk of hypertension. Conclusion Vitamin D deficiency is associated with risk of hypertension and there is an L-shaped relationship between 25-(OH)D concentration and risk of hypertension.

Surgical Management of Concurrent Strabismus and Face Turn in Patients with Infantile Nystagmus

PURPOSE: To investigate the effect of adjusted Kestenbaum surgery in patients with idiopathic infantile nystagmus who were affected by both strabismus and face turn. METHODS: This retrospective consecutive case series included 12 patients with infantile nystagmus who had face turn and strabismus. All patients underwent adjusted Kestenbaum surgery between 1996 and 2014, and primary outcome measures were the postoperative degree of face turn and strabismus. RESULTS: All patients had jerky nystagmus with compensatory face turn and strabismus. Of the 12 patients, eight patients were exotropes and four patients were esotropes. The mean age at surgery was 12.5 ± 10.7 years (range, 2–36 years). The mean postoperative follow-up was 17.8 ± 12.0 months (range, 7–43 months). Surgery was successful in eight (66.7%) out of 12 patients. Improvement of anomalous head posture was satisfactory in all patients, but an angle of deviation within 10 prism diopters was not achieved in four patients. CONCLUSIONS: Adjusted Kestenbaum surgery simultaneously improved both ocular misalignment and face turn with one-stage surgery. Two or three rectus muscles surgery can be considered in these patients because it is not only simpler than four muscles surgery but also can preserve one or two rectus muscles.

Association between Multimorbidity and Suicidal Ideation in Korean Elderly

BACKGROUND: Recent studies have reported that multimorbidity is associated with suicidality. The objective of this study was to evaluate the association between physical multimorbidity and suicidal ideation (SI) among the elderly.METHODS: A total of 6,712 subjects aged over 65 years without depression were analyzed from the Korea National Health and Nutrition Examination Survey databases (2010–2013, 2015). In our study, multimorbidity was defined as being diagnosed with two or more chronic diseases. The association between multimorbidity and SI was evaluated through multiple logistic regression analysis.RESULTS: Through our analysis, 40.7% of participants had multimorbidity and the 14.6% had SI. Multimorbidity was associated with suicidal ideation when adjusting for sociodemographic and health behavior covariates (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.14–1.55). However, no association between multimorbidity and SI existed after adjusting for additional health status factors. In subgroup analyses performed according to education level and health status, the risk of SI was high in subjects with multimorbidity only in those with below elementary school education level (OR, 1.36; 95% CI, 1.14–1.63). Further subgroup analysis indicated that the group without stress and the group without depressiveness both showed association of multimorbidity with SI (OR, 1.27; 95% CI, 1.02–1.59; OR, 1.28; 95% CI, 1.05–1.56).CONCLUSION: The study findings suggest that elderly with multimorbidity must be identified, evaluated, and managed for SI with special attention to those with education levels below elementary school. Physicians should also focus on assessing mental health status in the case of multimorbidity in the elderly without depression.

Refractive Outcomes of 4-Year-old Children after Intravitreal Anti-vascular Endothelial Growth Factor versus Laser Photocoagulation for Retinopathy of Prematurity

PURPOSE: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP). METHODS: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications. RESULTS: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (−1.0 diopters in the laser group and −0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, −0.007 to −0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group. CONCLUSIONS: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.

Regulation of angiotensin Ⅱ type 2 receptor in mechanically ventilated lung injury / 中华急诊医学杂志

Objective Through the study of angiotensin Ⅱ-type 2 receptor agonist(AT2R)after pretreatment of mechanical ventilation lung injury(VILI)in rats model,to clarify the role of angiotensin Ⅱ-type 2 receptor agonist(C21)in alleviating VILI inflammation and the damage of immune function and its possible mechanism.Methods In this experiment,the acute lung injury model was established by mechanical spring-volume ventilation in SD rats,and C21 pretreatment was performed to observe the pathological condition of lung tissue in rats with different ventilation duration,and to detect the inflammatory changes of BALF lavage fluid.Flow cytometry was used to detect the CD68+/INOS+labeled M 1 type Amφ and the CD68+/Arg-1+labeled M2 type Amφ in alveolar lavage fluid.Results The mechanical VILI rat model was successfully established.The pathological injury score of the mechanical ventilation 4 h model,the wet/dry weight of lung tissue,the number of cells and protein in BALF lavage fluid were increased significantly,the levels of TNF-α and IL-1 were increased significantly,the levels of IL-4 and IL-10 were decreased significantly,and the level of inflammatory reaction decreased with the increase of ventilation time.The M1/M2 ratio in the 4 h ventilation model group was the highest,which was significantly different from the control group(P＜0.05).Compared to the model group,the C21 pretreatment significantly reduced the levels of proinflammatory factors TNF-α and IL-1,and increased the levels of anti-inflammatory factors IL-4 and IL-10 in BALF(P＜O.O1).After the intervention of AT2R agonist at 4 h,6 h and 8 h,the M1/M2 ratio of the model was lower than that of the model without AT2R agonist at 4 h,6 h and 8 h.Conclusion Mechanical ventilation for 4 h in SD rats can establish a mechanical ventilation lung injury model.AT2R agonist C21 can promote the polarization of macrophages to m2-type,and C21 pretreatment may alleviate VILI inflammation and immune damage by altering the polarization of macrophages.