Paediatric one-day admission: why and is it necessary?

Introduction: Paediatric patients admitted to the inpatient units from the emergency department (ED) are increasing, but the mean length of stay has fallen significantly. We aimed to determine the reasons behind paediatric one-day admissions in Singapore and to assess their necessity. Methods: A retrospective study involving paediatric patients who were admitted from a general ED of an adult tertiary hospital to a paediatric tertiary hospital between 1 August 2018 and 30 April 2020. One-day admission was defined as an inpatient stay of less than 24 h from the time of admission to discharge. An unnecessary admission was defined as one with no diagnostic test ordered, intravenous medication administered, therapeutic procedure performed or specialty review made in the inpatient unit. Data were captured in a standardised form and analysed. Results: There were 13,944 paediatric attendances - 1,160 (8.3%) paediatric patients were admitted. Among these, 481 (41.4%) were one-day admissions. Upper respiratory tract infection (62, 12.9%), gastroenteritis (60, 12.5%) and head injury (52, 10.8%) were the three most common conditions. The three most common reasons for ED admissions were inpatient treatment (203, 42.2%), inpatient monitoring (185, 38.5%) and inpatient diagnostic investigations (32, 12.3%). Ninety-six (20.0%) one-day admissions were unnecessary. Conclusion: Paediatric one-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the ED, the paediatric patient and their caregiver, in order to safely slow down and perhaps reverse the trend of increased hospital admissions.

Correspondence: A combination of sectional micro-anatomy and micro-stereoscopic anatomy is an improved micro-dissection method.

It is easy to make errors in estimating the exact size and positioning of neural structures, especially when only using tomographic methods, as a lot of imagination and little precision is required. We found that combining the use of sectional micro-anatomy and micro-stereoscopic anatomy is much more accurate. We believe that our study makes a significant contribution to the literature because we believe that using improved methods to examine the neural structure is vital in future research on the micro-stereoscopic anatomy of the brain.

MYC and BCL-2 protein co-expression and prognosis of patients with diffuse large B-cell lymphoma: a propensity score matching analysis / 中华血液学杂志

Objective: We investigated the impact of MYC/BCL-2 protein co-expression on the prognosis of diffuse large B-cell lymphoma (DLBCL) patients and observed whether double expression (DE) remains an independent poor prognostic factor in DLBCL after the addition of therapeutic factors such as DA-EPOCH-R, central prophylaxis, and transplantation. Methods: Available pathological findings were retrospectively collected from 223 DLBCL patients at the Peking Union Medical College Hospital from 2015 to 2018. Seventy-five patients with high MYC/BCL-2 expression were categorized as the DE group. From the 148 non-DE patients, 75 DLBCL patients were selected as the control group, using a 1∶1 matching on propensity scores for age, international prognostic index score, treatment choice, and etc. The differences in overall survival (OS) and progression-free survival (PFS) between the two groups were compared. Results: The 3-year OS was (69.8±5.5) % for the DE group and (77.0±4.9) % for the non-DE group (P=0.225) , while the 3-year PFS was (60.7±5.8) % and (65.3±5.5) % , respectively (P=0.390) . Subgroup analysis in patients treated with the R-CHOP regimen revealed that for the DE and non-DE patients, the 3-year OS was (61.3±7.5) % and (77.2±5.6) % (P=0.027) , and the 3-year PFS was (52.1±7.5) % and (70.6±6.0) % (P=0.040) , respectively. Multivariate analysis showed that age, stage of Ann Arbor, COO staging, whether central prophylaxis was performed, and whether transplantation was performed were significant independent risk factors of the prognosis of DLBCL patients (P<0.05) . On the other hand, MYC/BCL-2 protein double expression was not significantly associated with prognostic outcomes. Conclusion: MYC/BCL-2 protein double expression was significantly associated with poor prognosis under R-CHOP regimen treatment, but the poor prognostic impact of DE on DLBCL was eliminated under intensive regimens such as DA-EPOCH-R and transplantation.

Ocular growth and metabolomics are dependent upon the spectral content of ambient white light.

Myopia results from an excessive axial growth of the eye, causing abnormal projection of remote images in front of the retina. Without adequate interventions, myopia is forecasted to affect 50% of the world population by 2050. Exposure to outdoor light plays a critical role in preventing myopia in children, possibly through the brightness and blue-shifted spectral composition of sunlight, which lacks in artificial indoor lighting. Here, we evaluated the impact of moderate levels of ambient standard white (SW: 233.1 lux, 3900 K) and blue-enriched white (BEW: 223.8 lux, 9700 K) lights on ocular growth and metabolomics in a chicken-model of form-deprivation myopia. Compared to SW light, BEW light decreased aberrant ocular axial elongation and accelerated recovery from form-deprivation. Furthermore, the metabolomic profiles in the vitreous and retinas of recovering form-deprived eyes were distinct from control eyes and were dependent on the spectral content of ambient light. For instance, exposure to BEW light was associated with deep lipid remodeling and metabolic changes related to energy production, cell proliferation, collagen turnover and nitric oxide metabolism. This study provides new insight on light-dependent modulations in ocular growth and metabolomics. If replicable in humans, our findings open new potential avenues for spectrally-tailored light-therapy strategies for myopia.

Association between celiac disease and vitiligo: A review of the literature.

Celiac disease (CD) is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes. Vitiligo is a commonly acquired depigmentation of the skin; its clinical manifestation are skin patches caused by localized or generalized melanin deficiency. Both diseases have similar global incidence rates (approximately 1%) and are associated to similar diseases, including autoimmune bullous disease, inflammatory bowel disease, autoimmune thyroiditis, autoimmune gastritis, and type 1 diabetes. The relationship between CD and vitiligo has been reported in several studies, but their conclusions are inconsistent. Further, it has also been reported that a gluten-free diet (GFD) can improve the symptoms of immune-related skin diseases such as vitiligo. In this mini-review, we summarize and review the literature on the relationship between CD and vitiligo, assess the therapeutic significance of GFD for patients with vitiligo, and explore their possible physiopathology. We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo, thereby improving the prognosis.

Transcallosal-lateral ventricle-choroid fissure approach for excising large pineal region tumors extending into the third ventricle: experience in 15 pediatric cases.

Pineal region is deep located and tightly connected with surrounding important nerves, blood vessels, and other critical structure. Tumors in the regions are more commonly observed in children with complex pathology, difficult surgery, and poor prognosis. However, excision surgery on large tumor in the pineal region and extending into the third ventricle is characterized by high difficulty and uneasy treatment. Related experience and knowledge about excising large tumor in children pineal region which extending into the third ventricle by transcallosal-lateral ventricle-choroid fissure approach was described in the paper. Clinical data of 15 children patients with large tumors in pineal region which extending into the third ventricle treated by our group from 2011 to 2015 was retrospectively analyzed (< 15 years of age, tumor size > >3 × 3 × 3 cm3). Fifteen cases underwent tumor excision with surgery by transcallosal-lateral ventricle-choroid fissure approach including 11 male patients and 4 female patients with average age of 9.1 years and tumor volume from 3 × 3 × 3 to 5 × 6 × 7 cm3. They were assessed according to postoperative clinical symptom remission rate, blood loss during surgery, tumor removal rate, postoperative recurrence rate, etc. as indicators. Five cases belonged to germ cell tumors, 4 for teratoma, 1 for malignant teratoma, 2 for glioma, 2 for meningioma, and 1 for pineocytoma. Surgical total excision rate was 100%, while the mean intraoperative blood loss was about 300 ml. No case was dead due to surgery, and all cases had good postoperative recovery. Children patients are characterized by less blood than adults, larger volume size during surgery treatment, poor postoperative anti-infectious ability, etc. High requirements are proposed on surgery treatment, by long-term clinical exploration and experience accumulation. Our group believes that surrounding structures such as veins and dome are stretched and stimulated rarely in excision of children in large and medium tumor in pineal region which extending into the third ventricle by transcallosal-lateral ventricle-choroid fissure approach; thereby, the tumor can be completely excised, and larger veins and other important structures can be well-preserved with fewer complications, high full cut rate, and rapid recovery.

The efficacy and safety of injection-related risk management based on WeChat platform in type 2 diabetic patients with the first insulin self-injection / 中华全科医师杂志

Objective:To assess the implementation of injection-related risk management based on WeChat platform for type 2 diabetic patients with the insulin self-injection.Methods:A total of 124 diabetic patients, who would receive insulin therapy by self-injection at home after discharge from the PLA 903 hospital during April 2017 to July 2018, were divided into the control group( n=62)and the study group( n=62). All patients were given routine education on insulin injection during the hospitalization,while the study group( n=62)received additional video and text education based on WeChat platform after discharge. The skill of self-injection and the status of blood glucose control were evaluated in both groups 4 weeks and 8 weeks after discharge, respectively. Results:The insulin injection skill, including skin disinfection [36(58%) vs. 11(18%),χ 2=21.42, P<0.01], exhaust before injection [62(100%) vs. 51(82%),χ 2=12.07, P<0.01], stay 10s after injection [60 (97%) vs. 47(76%),χ 2=11.52, P<0.01], disposal of used needle[49(79%) vs. 18(29%),χ 2=31.20, P<0.01], rotation of injection site [48(77%) vs. 35(56%),χ 2=6.16, P=0.01], insulin storage [62(100%) vs. 57(92%),χ 2=5.21, P=0.02], and the ability of correctly dealing with hypoglycemia [52(84%) vs. 38(61%),χ 2=7.94, P=0.01] in the study group were significantly better than those in the control group after 4 weeks of injection-related risk management. The fasting plasma glucose [(6.41±0.76) vs.(7.19±0.81)mmol/L, t=5.61, P<0.01], glycosylated hemoglobin A1c [(6.71±0.64)% vs. (7.37±0.78)%, t=5.18, P<0.01], incidence of hypoglycemia [6(10%) vs. 15(24%),χ 2=4.64, P=0.03] in the study group were significantly lower than those in the control group after 12 weeks of the management. Conclusion:The risk management based on WeChat platform can improve insulin self-injection skill and the ability of dealing with hypoglycemia,also promote effective blood glucose control for diabetes patients.

Association of Helicobacter pylori infection with colorectal polyps and malignancy in China.

BACKGROUND: Gastric Helicobacter pylori (H. pylori) infection is related to chronic gastritis, gastroduodenal ulcer, and gastric malignancies; whether this infection is related to colorectal polyps and colorectal cancer (CRC), remains debatable. AIM: To investigate the relationship between gastric H. pylori infection and the risk of colorectal polyps and CRC. METHODS: We retrospectively analyzed 3872 patients with colorectal polyps who underwent colonoscopy and pathological diagnosis. We also analyzed 304 patients with primary CRC. The characteristics of these patients were compared with those of the control group, which included 2362 patients with the normal intestinal mucosa. All subjects completed a 14C-urea breath test, bidirectional gastrointestinal endoscopy, and a biopsy on the same day. Data on the number, size, location, and pathology of the polyps, the location, and pathology of the CRC, the detection of H. pylori, and the incidence of H. pylori-associated atrophic gastritis or intestinal metaplasia were obtained. A logistic regression model was used to analyze the relationship between gastric infection due to H. pylori, and the incidence of colorectal polyps and CRC. RESULTS: The prevalence of H. pylori infection was higher in the multiple polyps group than in the solitary polyp group and the control group [95% confidence interval (CI) = 1.02-1.31, P = 0.03; 95%CI: 2.12-2.74, P < 0.001]. The patients with adenomatous polyps had a higher incidence of H. pylori infection than patients with non-adenomatous polyps [59.95% vs 51.75%, adjusted odds ratio (OR) = 1.41, 95%CI: 1.24-1.60, P < 0.01]. Patients with H. pylori-associated atrophic gastritis or intestinal metaplasia were at high risk of CRC (adjusted OR = 3.46, 95%CI: 2.63-4.55, P < 0.01; adjusted OR = 4.86, 95%CI: 3.22-7.34, P < 0.01, respectively). The size and location of the polyps, the histopathological characteristics and the location of CRC were not related to H. pylori infection. CONCLUSION: Our study demonstrates that the incidence of gastric H. pylori infection and H. pylori-associated atrophic gastritis or intestinal metaplasia elevates the risk of colorectal polyps and CRC.

Effectiveness and safety of different doses of pioglitazone in psoriasis: a meta-analysis of randomized controlled trials.

BACKGROUND: Pioglitazone may be beneficial in the treatment of psoriasis. However, based on the effectiveness and safety considerations, it has not been widely used. To fully evaluate the strength of evidence supporting psoriasis treatment with pioglitazone, we conducted a meta-analysis of existing published studies. METHODS: PubMed, Ovid, Cochrane Library, Google Scholar, and Web of Science databases were systematically searched before February 2019. Randomized controlled trials (RCTs) of pioglitazone administration compared with placebo, administered to patients with psoriasis for at least 10 weeks, and published in English were included. Quality of the included RCTs was identified by the modified Jadad scale. The quality of evidence for each outcome was evaluated using the GRADEpro Guideline Development Tool online software. Primary outcomes were proportion of patients showing psoriasis area and severity index (PASI) score improvement (>75%) and the mean percent change in PASI score from baseline to the end of treatment. Dichotomous data were analyzed using odds ratios (ORs) corresponding to the 95% confidence interval (CI), whereas continuous variables, expressed as mean and standard deviation, were analyzed using the mean differences (MD) with the 95% CI. RESULTS: Six RCTs were analyzed. Meta-analysis showed that pioglitazone reduced the PASI scores in patients with psoriasis compared with the control group when administered at 30 mg per day (P < 0.001, MD = -3.82, 95% CI = -5.70, -1.93) and at 15 mg per day (P = 0.04, MD = -3.53, 95% CI = -6.86, -0.20). The PASI-75 of the pioglitazone group was significantly higher than that of the control group at 30 mg per day (P < 0.001, OR = 8.30, 95% CI = 3.99, 17.27) and at 15 mg per day (P = 0.03, OR = 2.96, 95% CI = 1.08, 8.06). No statistically significant differences in total adverse events were observed between the groups. There were no significant differences in common adverse reactions such as weight gain and elevated liver enzymes between the two pioglitazone groups. CONCLUSIONS: Use of pioglitazone in the current treatment of psoriasis is beneficial. The therapeutic effect of the daily 30 mg dose may be greater than that of the 15 mg dose per day with no significant change in the frequency of adverse reactions.

Risk factors for infantile hemangioma: a meta-analysis.

BACKGROUND: Infantile hemangioma (IH) is one of the most common tumors in infants. Its pathogenesis is complex and poorly understood. The risk factors of IH have been extensively studied from clinical and epidemiological perspectives in recent years, but the conclusions in the literature reports are inconsistent. To provide a reference for the prevention of hemangioma, we conducted a meta-analysis of the published studies of potential risk factors for IH. METHODS: The Cochrane Library, Ovid, PubMed, and Web of Science databases were searched systematically. Log odds ratios (log ORs), logistic regression standard errors and 95% confidence intervals (CIs) were used to compare the correlation between IH and potential risk factors. Review Manager 5.3.3 was used for the statistical analysis. RESULTS: Six studies were included and 17 potential risk factors were eventually evaluated. P values < 0.05 were found for female gender (P < 0.01, OR 2.04, 95% CI 1.65-2.51), low birth weight (P < 0.01, OR 4.39, 95% CI 3.05-6.31), multiple gestation (P = 0.01, OR 2.39, 95% CI 1.21-4.71), preterm birth (P = 0.03, OR 2.37, 95% CI 1.07-5.23), progesterone therapy (P < 0.01, OR 2.73, 95% CI 2.12-3.51), and family history (P = 0.01, OR 1.98, 95% CI 1.16-3.38). CONCLUSIONS: This meta-analysis revealed that risk factors, including female gender, low birth weight, multiple gestation, preterm birth, progesterone therapy, and family history may affect the occurrence of IH.

Effect of kangaroo mother care on lactation, uterine involution and neonatal pain / 中国实用护理杂志

Objective:To explore the effect of kangaroo mother care (KMC) on lactation, uterine involution of parturients and neonatal pain.Methods:A total of 200 parturients who gave birth at full term in our hospital from January 2019 to June 2019 and their newborns were selected as the research objects, they were randomly divided into control group and observation group of 100 pairs each. The control group received routine obstetric postpartum care and the observation group received KMC. The KMC cognition, postpartum lactation and uterine involution, neonatal pain during neonatal heel blood collection were compared between the two groups.Results:The cognition of KMC in the observation group was significantly better than that in the control group, and the difference was statistically significant ( χ 2 value was 24.700, P<0.01). The first lactation time of parturients in the observation group was (41.25±3.20) hours after birth, which was earlier than (54.17±2.20) hours in the control group, there was significant difference between the two groups ( t value was 2.378, P value was 0.019). The breast pain Ⅰ degree (20 cases), Ⅱ degree (56 cases), Ⅲ degree (24 cases) in observation group were significantly lighter than those in control group (62, 27, 11 cases respectively) 72h after delivery, the differences were statistically significant ( t value was 12.166, P value was 0.011). The parturients of sufficient lactation in the observation group (73 cases) were more than those in the control group (34 case),the differences was statistically significant ( χ 2 value was 30.570, P value was 0.000). The uterine fundus of the observation group decreased by (3.06±1.26) cm and (1.67 ±0.43) cm at 24h and 48h postnatally, which were better than those of the control group (1.97±0.92) cm and (1.23±0.18) cm,the differences were statistically significant ( t value was 3.162, P value was 0.002; t value was 2.689, P value was 0.009). In the process of heel blood collection after 72h of delivery in both groups, the pain scores of the observation group during and after blood collection were 4.92±0.33 and 2.37±1.27 respectively, which were lower than those of the control group (5.57±1.37 and 5.01±1.09), and the differences were statistically significant ( t value was 2.035, P value was 0.046; t value was 2.579, P value was 0.011). The heart rates of the observation group during and after blood collection were (121.36±22.13) and (142.55±23.91) beats/min, respectively, which were lower than (152.64±18.21) and (156.79±17.37) beats/min of the control group, the difference were statistically significant ( t value was 2.375, P value was 0.018; t value was 2.126, P value was 0.037). The blood oxygen saturation of the observation group during and after blood collection were 0.967 2±0.013 7 and 0.985 5 ±0.022 4 respectively, which were significantly higher than 0.891 7±0.116 5 and 0.914 5±0.137 8 of the control group ( t value was 2.036, P value was 0.046; t value was 2.017, P value was 0.047). Conclusions:The implementation of KMC can promote lactation, accelerate uterine involution, and relieve the pain of neonats during neonatal heel blood collection; Strengthening the health education of KMC can improve the cognition of parturients and their families about KMC, which has positive significance in promoting maternal and infant health and is worthy of clinical application.

Bowen's disease on the palm: A case report.

BACKGROUND: Bowen's disease (BD) is a persistent, progressive intraepidermal carcinoma. BD usually occurs in areas exposed to sunlight. Involvement of the dorsum of the hand is not rare, but that of the palmar aspect is very unusual. Only a few cases have been reported in the literature. CASE SUMMARY: Here, we report the case of a 48-year-old male patient who presented with a history of persistent local erythema lasting for 2 years on the thenar eminence of the left palm. Initially diagnosed as hand eczema, the condition did not improve with intermittent treatment with anti-allergy medications or topical glucocorticoid ointments, among other approaches. Then, the area of erythema gradually enlarged and was accompanied by mild itching. For a definite diagnosis and treatment, the patient came to our hospital. Dermoscopic examination revealed BD, and histopathological examination confirmed the diagnosis. We performed partial resection of the skin lesion followed by photodynamic therapy. No recurrence was observed at the 6-mo follow-up. CONCLUSION: For all atypical palmar lesions, early dermoscopy and/or skin biopsy are needed to avoid missed diagnosis or misdiagnosis.

Author Correction: Efficacy of alprostadil for preventing of contrast-induced nephropathy: A meta-analysis.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Superhydrophobic foam prepared from high internal phase emulsion templates stabilised by oyster shell powder for oil-water separation.

In this paper, poly(styrene-divinylbenzene) foams were synthesized using a high internal phase emulsion (HIPE) technique with Span 80 and with 900 °C calcined oyster shell powder as a co-emulsifier, 2,2'-azobisisobutyronitrile (AIBN) as an initiator and deionized water as the dispersing phase. SEM images revealed that the materials possess a hierarchical porous structure of nano/micro size, which resulted in saturated oil adsorption in only half a minute. The dispersing phase amount was investigated for its effect on adsorption. The optimized foams have 24.8-58.3 g g-1 adsorbencies for several organic solvents, and they demonstrated superhydrophobicity and excellent oleophilicity with the water contact angle (WCA) even close to 149° and oil contact angle approaching 0°. Moreover, the foams displayed high oil retention under pressure. The adsorption-centrifugation cycling results indicated high repeatability of the recovered foams. All of these features predicted the potential applications of superhydrophobic foams in oil-water separation.

Thyroid lymphoma progressed with Hashimoto's thyroiditis diagnosed by core-needle biopsy : case report and literature review / 中华内分泌代谢杂志

Objective To explore the significance of core-needle biopsy ( CNB) in the diagnosis of thyroid lymphoma. Methods A case of Hashimoto's thyroiditis for several decades, showed a thickening of the neck for several months, and no abnormalities were found by the method of fine-needle aspiration( FNA), then we performed CNB and flow cytology. Results Thyroid lymphoma was finally diagnosed through CNB and flow cytology. Conclusion Thyroid lymphoma should be considered when the neck became thickened in short time in patients with chronic Hashimoto's thyroiditis. Core-needle biopsy accompanied with flow cytometry and immunohistochemistry analysis should be suggested as routine diagnostic method especilly when fine-needle aspiration was negative.

Vitamin D receptor gene polymorphism, serum 25-hydroxyvitamin D levels, and risk of vitiligo: A meta-analysis.

OBJECTIVES: To explore the relationship among the vitamin D receptor (VDR) gene polymorphisms, serum 25-hydroxyvitamin D levels, and vitiligo. METHODS: Databases including PubMed, Cochrane Library, Ovid, Web of Science, CNKI, SinoMed, and Wanfang Data were systematically searched. The association was assessed using odds ratios (ORs), standard mean difference (SMD), and 95% confidence intervals (CIs). The statistical tests were performed using Review Manager 5.3.3. RESULTS: We identified a total of 17 studies. The relationship between VDR gene polymorphisms (BsmI, ApaI, TaqI, and FokI), serum 25 (OH)D levels, and incidence of vitiligo was investigated. The results of this meta-analysis showed that the dominant genetic model (CC+AC vs AA, P = .007, OR = 1.41, 95% CI = 1.10-1.80), recessive genetic model (CC vs AC+AA, P = .01, OR = 4.10, 95% CI = 1.36-12.35), and allelic contrast model (C vs A, P = .005, OR = 1.87, 95% CI = 1.21-2.90) of VDR Apal locus increased the risk of vitiligo, and BsmI, TaqI, and FokI loci and the risk of vitiligo have no obvious correlation. Serum 25 (OH)D deficiency was positively associated with the incidence of vitiligo (P < .0001, SMD = -0.94, 95% CI = -1.39, -0.48). CONCLUSION: This meta-analysis revealed that VDR Apal polymorphism increased the susceptibility risk of vitiligo, and there is a positive correlation between serum 25 (OH)D deficiency and the incidence of vitiligo.

Pupillary Responses to Full-Field Chromatic Stimuli Are Reduced in Patients with Early-Stage Primary Open-Angle Glaucoma.

PURPOSE: To evaluate the ability of chromatic pupillometry to reveal abnormal pupillary responses to light in patients with early-stage primary open-angle glaucoma (POAG) and to test whether the degree of pupillometric impairment correlates with structural hallmarks of optic nerve damage in the disease. DESIGN: Cross-sectional study. PARTICIPANTS: Forty-six patients with early-stage POAG (63.4±8.3 years, 63% male, 87% ethnic-Chinese) and 90 age-matched healthy controls (61.4±8.6 years, 34% male, 89% ethnic-Chinese). Patients with POAG had a visual field mean deviation (VFMD) of -6 decibels or better on automated perimetry. METHODS: Each participant underwent a monocular 2-minute exposure to blue light (462 nm) followed by another 2-minute exposure to red light (638 nm) using a modified Ganzfeld dome equipped with a light-emitting diode lighting system. The light stimuli intensity was increased logarithmically to evaluate the combined extrinsic and intrinsic response of intrinsically photosensitive retinal ganglion cells (ipRGCs). Light-induced changes in horizontal pupil diameter were assessed monocularly using infrared pupillography. MAIN OUTCOME MEASURES: Baseline-adjusted, light-induced pupillary constriction amplitudes were calculated, and individual irradiance-response curves were constructed for each stimulus. Pupillary constriction amplitudes were compared between groups and across light intensities using a linear mixed model analysis. The linear relationship between pupillometric parameters and different structural and functional features of glaucoma was assessed using Pearson's correlation analysis. RESULTS: Light-induced pupillary constriction was reduced in patients with early-stage POAG compared with controls at moderate to high irradiances (≥11 Log photons/cm2/s) of blue (P = 0.003) and red (P < 0.001) light. Maximal pupillary constriction amplitude was correlated with retinal nerve fiber layer thickness (RNFL) thickness (blue: r = 0.51, P < 0.001; red: r = 0.45, P = 0.002) in patients with POAG but not in controls. Conversely, pupillometric parameters were not correlated with visual field scores in patients with early-stage POAG. CONCLUSIONS: Patients with early-stage POAG exhibit reduced pupillary responses to moderate and high irradiances of blue and red lights. This wavelength-independent functional alteration correlates with structural thinning of the RNFL and could be the consequence of dysfunction or loss of melanopsin expressing ipRGCs in the early stages of the disease.

Effect of sorafenib on growth and circadian clock gene expression of human hepatocellular carcinoma in nude mice / 中华肝胆外科杂志

Objective To investigate the function of sorafenib on the growth of hepatocellular carcinoma by establishing subcutaneous transplantation tumor model with nude mice.To explore the effect of sorafenib on circadian clock gene expression in hepatoma cells.Methods Mouse tumor model was established by implanting hepatocarcinoma cell (HepG2) subcutaneously in Balb/C nude mice.Sixteen experimental mice were randomly divided into two groups:sorafenib treatment group (n =8) and solvent control group (n =8).The nude mice were treated with sorafenib (100 mg/kg) and DMSO daily by intragastric administration,respectively.The volume of tumors was recorded every 3 days.The expressions level of circadian clock genes (Per1,Per2,Per3,CLOCK,Cry1,Cry2,BMAL1 and CKIε) were detected by real-time polymerase chain reaction (Real-time PCR).The correlations between the size of the xenografts and the expressions of the circadian clock genes were further analyzed.Results Compared with the control group,the tumor size in the sorafenib treatment group were significantly smaller comparing with the control group.Results of Real-time PCR showed that the expression level of Per1,Cry1 and BMAL1 mRNA was remarkably decreased in the treatment group (Per1,P =0.02;Cry1,P =0.002;BMAL1,P =0.035),the differences were statistically significant.Correlation analysis showed that the size of subcutaneous transplantation tumorsin nude mice was negatively correlated with the expressions of Per1,Per2,Cry1 and Cry2 mRNA in control group.While,the size of subcutaneous transplantation tumors was negatively correlated with the expressions of Per2,Per3 and BMAL1 levels in the sorafenib treatment group.Conclusions There is a negative correlation between the expression levels of some biological clock genes and the size of transplantation tumor in nude mice.Sorafenib treatment significantly inhibited the growth of hepatocellular carcinoma in nude mice and down-regulation the expressions of Per1,Cry1 and BMAL1 mRNA in hepatoma cells.

Relevance between GerdQ score and the severity of reflux esophagitis in Uygur and Han Chinese.

Gastroesophageal reflux disease questionnaire (GerdQ) was used to investigate the inpatients with typical reflux related symptoms in Gastroenterology. According to heartburn, regurgitation, abdominal pain, nausea, sleep disorders, whether taking over the counter (OTC) drugs 6 points to score. Using endoscopy as the gold standard for the diagnosis of reflux esophagitis (RE), and the results were compared with GerdQ score to determine the threshold value for RE, to analyze the distribution of GerdQ score for patients with RE, to assess the relationship between the GerdQ score and the severity of RE. A total of 1233 patients were enrolled in this study, including 538 patients had RE and 695 had not. There was statistical significance in the GerdQ score of RE group and non-RE group (P <0.05), showing that significant correlation between the score and the occurrence of RE. GerdQ score and the severity of RE were positively correlated. Further research also showed that there was a direct correlation between GerdQ score and the severity of RE in the Uygur and Han. GerdQ seems to be an useful screening tool in initial diagnosis of RE, and positively correlated with the severity of RE.