[The 505th case: refractory ascites and monoclonal immunoglobulin].

A 52-year-old woman was admitted with a primary complaint of abdominal distension and increased abdominal circumference for more than half a year. There was no evidence of infection or solid tumor on abdominocentesis or laparoscopic surgery. Concurrently, smoldering multiple myeloma was diagnosed. Due to refractory ascites and portal hypertension, a transjugular intrahepatic portosystemic shunt was performed, but the efficacy was not satisfactory. As the anemia progressed, she was finally diagnosed with active multiple myeloma after monoclonal plasma cells were detected in the ascites by flow cytometry. Treated with a triplet regimen that included bortezomib, cyclophosphamide, and dexamethasone (BCD), she achieved a very good partial response and ascites regressed.

[Research advances in myopic children with dry eye].

Myopia is a global public health issue, particularly prevalent in China, with a rising trend in recent years. The increased use of computers, smartphones, and video display terminals has led to frequent dry eye symptoms, such as blinking, among myopic students. Studies have revealed a higher incidence of dry eye in myopic children compared to emmetropic children, significantly impacting their learning and quality of life. However, ophthalmologists have traditionally focused more on the prevention and control of myopia, often neglecting ocular surface health awareness in children. It is essential to understand the potential impact of myopia on dry eyes in children and whether there is a difference in dry eye prevalence. This article reviews the current state of research on childhood myopia-related dry eye, encompassing epidemiology, pathogenesis, and risk factors, aiming to provide clinical reference for intervention, prevention, and precise treatment of dry eyes in myopic children.

Clinical research advances of CFHR5 nephropathy: a recent review.

CFHR5 nephropathy is a type of clinical C3 glomerulopathy, which is a monogenic genetic disease caused by the internal replication of CFHR5 gene, a protein related to the complement regulatory factor H family. The disease seems to be prevalent only in people of Greek Cypriot descent. Because of the special variation of the internal replication of exon 2 and exon 3 of CFHR5 protein in the occurrence of disease, it has had a serious impact on local residents. At present, the mechanism of glomerular damage caused by CFHR5 protein mutations is still unclear. The purpose of this article is to review the clinical research advances of this disease in the past 10 years, including the study of mutant genes, the analysis of mutant proteins and the role of alternative pathways in glomerular injury. It covers the progress in diagnosis and clinical treatment of the disease and looks forward to the future development prospects of its treatment. It is hoped that the recent results will be summarized for the follow-up in-depth study of CFHR5 nephropathy.

[Investigation and analysis of airborne allergenic pollen in 4 districts and 5 counties of Hohhot City].

Objective: To investigate the species, concentration and seasonal trends of main airborne allergenic pollen in 4 districts and 5 counties of Hohhot City. Methods: The Department of allergy, Beijing Shijitan Hospital Affiliated to Capital Medical University conducted a cross-sectional study about monitoring the airborne allergenic pollen from August 1, 2021 to July 31, 2022 by the gravitational method in 4 districts and 5 counties of Hohhot City, which include Yuquan District, Xincheng District, Huimin District, Saihan District, Tuoketuo County, Helingeer County, Tumotezuoqi County, Wuchuan County and Qingshuihe County. Daily pollens were counted and identified by optical microscopy, and the data were analyzed. Results: The airborne allergenic pollen was collected every month all year round in 4 districts and 5 counties of Hohhot city. Through the whole year of the total quantity of pollens ranged from 24 850 to 50 154 grains per 1 000 mm2 and two peaks of pollen concentration in air were observed,which happened in spring (from March to May) and in summer and autumn (from July to September). In spring, the main pollens were tree pollens, which principally distributed in Populus pollen (18.29%), Ulmus pollen (8.36%), Pinus pollen (6.20%), Cupressaceae pollen (5.23%), Betulaceae pollen (2.73%), Salix pollen (1.80%) and Quercus pollen (1.16%). In summer and autumn, the main pollens were weed pollens, which mainly included Artemisia pollen (42.73%), Chenopodiaceae pollen or Amaranthaceae pollen (7.46%), Poaceae pollen (2.26%), Humulus pollen or Cannabis pollen (0.60%). Conclusion: There were two peaks of main airborne allergenic pollen in 4 districts and 5 counties of Hohhot City. In the spring peak of pollen, the main airborne pollens were tree pollens. In the summer and autumn peak of pollen, the main airborne pollens were weed pollens. The Artemisia pollen was the most major airborne pollen in this area.

[Efficacy and prognostic analysis of orthopedic surgery in patients with newly diagnosed multiple myeloma].

Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ2-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.

Identification of key genes and molecular pathways in type 2 diabetes mellitus and polycystic ovary syndrome via bioinformatics analyses.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) and polycystic ovary syndrome (PCOS) are highly prevalent endocrine system diseases. However, studies on the molecular mechanisms of T2DM and PCOS at the transcriptomic level are still few. Thus, we aimed to reveal the potential common genetic and molecular pathways between T2DM and PCOS via bioinformatics analyses. MATERIALS AND METHODS: We downloaded the GSE10946 and GSE18732 datasets for T2DM and PCOS, respectively, from the National Center for Biotechnology Information's Gene Expression Omnibus (GEO) database. These datasets were subjected to integrated differential and weighted gene co-expression network analyses (WGCNA) to screen common genes. Thereafter, functional enrichment and disease gene association analyses were performed, transcription factor (TF)-gene and TF-miRNA-gene regulatory networks were constructed, and finally, the relevant target drugs were identified. RESULTS: We identified common genes (BIRC3, DEPTOR, TNNL3, ADRA2A) in T2DM and PCOS. Pathway enrichment analysis depicted that the common genes were enriched in smooth muscle contraction, channel inhibitor activity, apoptosis, and tumor necrosis factor (TNF) signaling pathways. TFs such as SP7, KLF8, HCFC1, IRF1, and MLLT1 played key roles in TF regulatory networks. Orlistat was indicated to be an important gene-targeting drug. CONCLUSIONS: This study is the first study to explore four diagnostic biomarkers and gene regulatory networks for T2DM and PCOS. The findings of our study provide novel insights into the diagnosis and treatment of T2DM and PCOS.

[The influencing factors of renal response in newly diagnosed multiple myeloma patients with renal impairment].

Objective: To investigate the causative factors of renal function in newly diagnosed multiple myeloma (MM) patients with renal inadequacy. Methods: 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited, whose baseline chronic kidney disease (CKD) stage was 3-5. Statistical analysis was performed based on laboratory tests, treatment regimens, hematological responses, and survival among various renal function efficacy groups. A logistic regression model was employed in multivariate analysis. Results: A total of 181 patients were recruited, and 277 patients with CKD stages 1-2 were chosen as controls. The majority choose the BCD and VRD regimens. The progression-free survival (PFS) (14.0 months vs 24.8 months, P<0.001) and overall survival (OS) (49.2 months vs 79.7 months, P<0.001) of patients with renal impairment was considerably shorter. Hypercalcemia (P=0.013, OR=5.654) , 1q21 amplification (P=0.018, OR=2.876) , and hematological response over a partial response (P=0.001, OR=4.999) were independent predictive factors for renal function response. After treatment, those with improvement in renal function had a longer PFS than those without (15.6 months vs 10.2 months, P=0.074) , but there was no disparity in OS (56.5 months vs 47.3 months, P=0.665) . Conclusion: Hypercalcemia, 1q21 amplification, and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment. MM patients with CKD 3-5 at baseline still have worse survival. Improvement in renal function after treatment is attributed to the improvement in PFS.

An approach combining bioinformatics and machine learning to identify eight autophagy-related biomarkers and construct molecular mechanisms underlying COVID-19 and major depressive disorders.

OBJECTIVE: A lack of objective biomarkers is preventing the screening and diagnosis of COVID-19 combined with major depression disorder (COVID-19-MDD). The purpose of this study was to identify diagnostic biomarkers and gene regulatory mechanisms associated with autophagy; a crucial process significantly involved in the pathogenesis of COVID-19-MDD. MATERIALS AND METHODS: In this study, differentially expressed genes (DEGs) were screened using GSE98793 from the GEO2R analysis (GEO) database, and intersected with the COVID-19-related gene (CRGs) and autophagy-related genes (ARGs) to obtain common genes involved in. Then, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of these common genes were performed. Subsequently, the transcription factor (TF)-gene regulatory network and comorbidity network were constructed. In addition, 10 drug candidates were screened using the DSigDB database. To identify diagnostic markers, we used LASSO regression. RESULTS: In total, 13 common genes were screened, which were primarily enriched in lysosomes, endoplasmic reticulum membranes, and other endomembrane systems also associated with autophagy. Additionally, these genes were involved in neurological cell signaling and have a functional role in pathways related to vascular endothelial growth factor, tyrosine kinase, autophagy, inflammation, immunity, and carcinogenesis. Tumors and psychiatric disorders were the most highly linked diseases to COVID-19. Finally, ten drug candidates and eight diagnostic markers (STX17, NRG1, RRAGD, XPO1, HERC1, HSP90AB1, EPHB2, and S1PR3) were screened. CONCLUSIONS: This is the first study to screen eight diagnostic markers and construct a gene regulatory network for COVID-19-MDD from the perspective of autophagy. The findings of our study provide novel insights into the diagnosis and treatment of COVID-19-MDD.

[Considering the influence of age-related factors on the strategy and satisfaction of refractive surgery].

With the rapid development of materials, equipment and technology related to refractive surgery, the number of people who choose refractive surgery to take off glasses keeps increasing. People at different ages have different needs for refractive surgery with varying effects. How to improve the long-term postoperative satisfaction of patients at different ages should be the focus of refractive surgeons. Age-related factors are not only among the key considerations in the preoperative design of refractive surgery, but also the focus of preoperative communication and education and postoperative follow-up. By analyzing and discussing the influence of age-related factors on the strategy of refractive surgery, this article emphasizes that it is important to pay attention to age-related factors and strengthen perioperative education in ametropic patients, so as to obtain long-term ideal postoperative visual quality and improve patient satisfaction throughout the life cycle.

[Anterior segment OCT-assisted PTK combined with PRK in the treatment of myopia associated with cornea macula: a case report].

Nowadays, myopia morbidity keeps increasing in China. As the improvements of technique and safety in corneal refractive surgeries, an increasing number of patients with refractive error tend to choose these treatments. The 26-year-old woman with myopia in this case, whose UCVA was 0.1 in OD and 0.2 in OS, had corneal macula in the nasal side of the left eye owing to a corneal trauma occurred more than 10 years ago. After sufficient preoperative examinations, FS-LASIK was performed on the right eye and PTK combined with PRK was performed on the left eye. The UCVA was 1.2 in both eyes 3 months postoperatively, and the corneal macula was mostly cleared in the left eye. It is demonstrated that PTK combined with PRK is an effective and safe way to correct the diopter as well as remove the lesions for the lowly or moderately myopic patients accompanied with superficial corneal opacity. (Chin J Ophthalmol, 2021, 57: 614-617).

[Thought of corneal collagen cross-linking combined with excimer laser ablation for irregular corneas in keratoconus].

The concept of diagnosis and treatment of keratoconus is constantly updated. Today, we are not only concerned with how to delay the progress of the disease, but also with the preservation of useful vision for patients as well as improvement of visual quality. With the precise and individualized application of excimer laser and femtosecond laser technology in ophthalmology, corneal cross-linking combined with excimer laser ablation for the irregular cornea has become a new strategy for keratoconus. However, questions have been raised and caused ophthalmologists' thinking. Are patients with keratoconus who have progressively thinned corneas suitable for excimer laser ablation? Which is better when the combined strategy is applied, simultaneous or sequential surgery? Based on the research data from home and abroad, we comprehensively sort out various treatment methods for the focus issues. It is hoped that this article can provide guidance for the rational selection of an optimal clinical solution to keratoconus. (Chin J Ophthalmol, 2021, 57:251-253).

[Regulation of bFGF and TGF-ß2 in human scleral fibroblasts by the lumican gene mutation associated with myopia].

Objective: To investigate the regulation of basic fibroblast growth factor (bFGF) and transforming growth factor (TGF)-ß2 in human scleral fibroblasts (HSFs) by the adenovirus-mediated Lumican gene mutation, and to illustrate the effect of this mutation on myopia. Methods: Experimental study. The HSFs were isolated and cultured from human scleral tissues. The 3rd to 5th generation HSFs were transduced with Lumican mutant (c.596T>C) adenovirus, Lumican wild-type adenovirus, and defective adenovirus as the mutant group, wild group, and negative control group, respectively. Untransduced HSFs were defined as control group. The operation was conducted three times in each group. The expression levels of Lumican, bFGF and TGF-ß2 were detected by qPCR. Statistical analysis of gene expression differences between groups was performed by fold changes. The differences were analyzed by one way ANOVA combined with LSD-t test. Results: The expressions of Lumican in the mutant group and the wild group were 103.146-fold and 398.646-fold increased compared to the control group with significant difference (t=-16.641, -21.729; P<0.05). There was no statistical difference between the negative control group and the control group (t=1.689, P>0.05). The expressions of bFGF and TGF-ß2 in the mutant group were 2.812-fold and 2.346-fold increased compared to the control group with significant difference, and higher than the other groups (t=-3.921, -4.851; P<0.05). There was no significant difference among the wild group, negative control group and control group (P>0.05). Conclusions: The Lumican mutation (c.596T>C) increased the expressions of bFGF and TGF-ß2 in HSFs. It indicates that the Lumican mutation (c.596T>C) may change the metabolism of extracellular matrix in the sclera by regulating bFGF and TGF-ß2 to participate in scleral remodeling during the process of myopia. (Chin J Ophthalmol, 2021, 57:277-283).

[Strengthening the safety of phakic intraocular lens implantation for myopia and astigmatism].

With the improvement of intraocular lens materials and function design, phakic intraocular lens implantation has been widely carried out for myopia and astigmatism and achieved satisfactory clinical results at home and abroad. The range of corrected myopia diopters has gradually changed from previous super-high and high myopia to low myopia. With the expansion of the scope of indications and applications, it is necessary to strengthen the standardization of phakic intraocular lens implantation for myopia and astigmatism, and it is particularly important to further improve its safety and quality control. This article discusses how to rationally select indications, increase the accuracy of the design, and effectively prevent surgical complications, providing a reference for further improvement of clinical safety and quality control. (Chin J Ophthalmol, 2021, 57: 86-89).

MicroRNA-1274a serves as a prognostic biomarker in patients with osteosarcoma and is involved in tumor progression via targeting ADAM9.

Osteosarcoma (OS) is the most frequent primary malignancy in bone, and commonly occurs in children and adolescents. The aim of this study was to assess the aberrant expression of miR-1274a in OS patients, and to evaluate the role of miR-1274a as a prognostic biomarker and tumor suppressor in OS progression. miR-1274a expression was estimated using quantitative real-time polymerase chain reaction. The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic value of miR-1274a in OS. Gain- and loss-of-function in vitro experiments were used to explore the functional role of miR-1274a in OS progression. A target gene of miR-1274a was analyzed using a dual-luciferase reporter assay. miR-1274a expression was decreased in OS tissues and associated with distant metastasis and clinical stages in OS patients. Low miR-1274a could predict poor overall survival and disease-free survival in OS. The overexpression of miR-1274a could inhibit OS cell proliferation, migration and invasion. Additionally, ADAM9 was demonstrated to serve as a direct target of miR-1274a in OS cells. In conclusion, reduced miR-1274a predicts poor prognosis and serves as a potential tumor suppressor in OS. ADAM9 is a target of miR-1274a, which may mediate the functional role of miR-1274a in OS progression.

Clinical-grade Garcinia cambogia extract dissolves calcium oxalate crystals in Drosophila kidney stone models.

OBJECTIVE: Kidney stone formers have a high rate of stone recurrence after kidney stone removal surgery and there is no effective medication for treatment. Hydroxycitric acid (HCA), which is the major component of Garcinia cambogia extract, can dissolve calcium oxalate crystals in vitro, suggesting that Garcinia cambogia could be used to treat calcium oxalate kidney stone. In this study, we used the Drosophila kidney disease model to evaluate the effect of Garcinia cambogia on the prevention and removal of calcium oxalate stones in vivo. MATERIALS AND METHODS: Flies were reared in fly food containing different concentrations of GCE for one week. The effect of GCE on preventing the formation of calcium oxalate stone was examined. WT and v-ATPase gene RNAi knockdown flies were reared in fly food with 0.3% NaOx for one week, then fed different concentrations of GCE for one week. The effect of GCE on the removal of calcium oxalate stone was examined. RESULTS: Garcinia cambogia extract dissolves calcium oxalate crystals from Malpighian tubules in both genetic and non-genetic Drosophila kidney stone models compared to citric acid. Hydroxycitric acid also directly dissolves calcium oxalate crystals in Drosophila Malpighian tubules ex vivo. CONCLUSIONS: Garcinia cambogia extract removes calcium oxalate kidney stones from Drosophila Malpighian tubules via directly dissolving calcium oxalate stones by HCA. Our study strongly suggests that clinical-grade Garcinia cambogia extract could be used to treat patients with nephrolithiasis in the future.

[Enhancing the management and control of perioperative infection in small incision lenticule extraction].

Small incision lenticule extraction (SMILE) has been widely used in the treatment of myopia and astigmatism due to its small incision (2 mm), without open corneal flap, rapid recovery of the ocular surface function and good comfort. However, it is the microincision and the potential cavity under the corneal cap that provide a suitable environment for microbial nourishment. In this article, the characteristics of SMILE and the particularity of postoperative infection are stated, and the key points of risk management and control during the period of operation as well as the principles of identification and treatment of infection after SMILE surgery are put forward, so as to enhance the perioperative preparation in SMILE and make sure of the safety and high quality for myopic eyes. (Chin J Ophthalmol, 2020, 56: 86-88).

[Assessment of corneal biomechanical changes after small incision lenticule extraction with Pentacam and Corvis ST].

Objective: To investigate the application value of Pentacam combined with Corvis ST in evaluation of the changes of corneal biomechanics after femtosecond laser small incision lenticule extraction (SMILE) in Chinese myopia with an irregular cornea. Methods: The clinical records for 104 eyes of 57 patients who received SMILE in the Refractive Center of Beijing Tongren Hospital during January 2018 and May 2018 were collected. According to the keratoconus severity index (KSI), they were divided into two groups: regular corneal group (KSI<15%) and irregular corneal group (KSI: 15% to 25%). In both groups, the anterior corneal surface radius curvature was>7.25 mm (K<46.50 diopters), the posterior corneal surface radius curvature was>5.90 mm, the thinnest pachymetry was>490 µm, and best corrected visual acuity was ≥1.0. The vision, refraction, and corneal biomechanics before and after SMILE were assessed. The Topographic and Biomechanics Index (TBI) was analyzed by Pentacam combined with Corvis ST. Results: Before SMILE, the Corvis Biomechanical Index (CBI), TBI, and Belin/Ambrósio Deviation Normalized Index (BADD) of the irregular corneal group were significantly higher (t=-2.17, -6.78, -4.37, P<0.05) than the regular corneal group, while the stiffness parameter (SPA1) was significantly lower (t=2.58, P=0.011) compared to the regular corneal group (P<0.05). In the irregular group, the TBI was (0.28±0.2); the maximum value was 0.03, and the minimum value was 0.43. The CBI was (0.09±0.21); the maximum value was 0.00, and the minimum value was 0.54. The BADD was (1.33±0.47); the maximum value was 0.42, and the minimum value was 2.26. In the regular group, the TBI was (0.05±0.08); the maximum value was 0.00, and the minimum value was 0.20. The CBI was (0.01±0.03); the maximum value was 0.00, and the minimum value was 0.17. The BADD was (0.92±0.46); the maximum value was 0.00, and the minimum value was 1.64. There was no significant difference between two groups in age (t=0.20, P=0.508), central corneal thickness (t=1.64, P=0.104), biomechanical corrected IOP (t=0.73, P=0.468), max inverse radius (t=-0.24, P=0.815), spherical equivalent (t=-0.97, P=0.335), and best corrected visual acuity (t=0.21, P=0.833). After SMILE, the deformation amplitude in the irregular group was significantly higher at 1 month and 3 months (t=-3.13, -3.09, P<0.05). The irregular group had a significantly higher deformation amplitude ratio at 1 week, 1 month, and 1 year (t=-2.72, -3.39, -2.51, P<0.05). The SPA1 in the irregular group was significantly lower than the regular group at 1 week, 1 month, and 3 months (t=2.11, 2.73, 3.70, P=0.335, 0.010,<0.001). The changes of deformation amplitude (t=0.50, -1.10, -0.73, 2.12, P>0.05), max inverse radius (t=-1.52, -1.41, 0.01, -0.79, P>0.05), and SPA1(t=0.89, 0.90, 1.12, 0.90, P>0.05) after SMILE were similar between the irregular and regular groups, except that at 1 month after SIMILE, the deformation amplitude ratio changed more significantly in the irregular group (t=-3.01, P=0.003). Conclusions: The changes of corneal biomechanics in the groups of regular cornea and irregular cornea were stable with no significant difference during 1 year of post-SMILE. The diagnosis based on the corneal topography and corneal biomechanics is of certain significance for the screening of early keratoconus before keratorefractive surgery. (Chin J Ophthalmol, 2020, 56:103-109).

[New progress in the reuse of human corneal stromal lenticules from SMILE].

With the extensive development of small incision lenticule extraction (SMILE), a large number of human corneal stromal lenticules were extracted integrally during the operation, which led some experts to study the reuse of the lenticules. In experimental research, the lenticules were used to culture fibroblasts, construct corneal scaffolds and describe the biomechanical behaviors of cornea by cytobiology, immunology and biomechanics. In clinical study, the lenticules had been successfully reimplanted into autologous or allogenic cornea of human subjects for correcting hyperopia and presbyopic, patching corneal perforation and treating defective keratopathy and so on. (Chin J Ophthalmol, 2020, 56:144-148).

[Endothelial dysfunction in children with obstructive sleep apnea syndrome].

Objective: To evaluate the endothelial function in obstructive sleep apnea syndrome(OSAS) children and to identify related factors of endothelial dysfunction. Methods: This was a cross-sectional study. Children with habitual snoring (snoring ≥3 nights per week) admitted to the ward of otolaryngology, head and neck surgery, Beijing Children's Hospital were recruited to this study between 1(st) June 2015 and 1(st) March 2016. All children aged 3 to 11 years and of them 245 were boys and 110 were girls. All subjects underwent an overnight polysomnography (PSG), as well as endothelial function testing. All subjects were grouped into primary snoring (PS) and OSAS group according to the obstructive apnea hypopnea index (OAHI). T test or Wilcoxon test were used to compare the differences in PSG results between the two groups, and univariate and multivariate correlation analyses were used to explore the relevant factors affecting the endothelial function. Results: A total of 355 subjects were enrolled and 248 had OSAS, and 107 had PS. There were no significant differences in age, gender and body mass index (BMI) Z-score between the two groups (all P>0.05). OSAS group had higher OAHI, oxgen desaturation index and respiratory related arousal index (5.2 (2.2, 13.2) vs. 0.4 (0.1, 0.7), 4.1 (2.0, 13.1) vs. 0.5 (0.1, 1.0), 2.5 (1.0, 4.8) vs. 0.4 (0.1, 0.9), Z=-14.957, -11.790, -10.378, all P<0.01), and lower minimum oxygen saturation and reactive hyperemia index (RHI) than those of PS (0.89 (0.85, 0.92) vs. 0.94 (0.91, 0.95), 1.2±0.2 vs. 1.1±0.1, Z=-9.337, t=5.354, P<0.01). Univariate regression analysis showed that RHI was linearly correlated with age (parameter estimate=0.017, P<0.01), gender (parameter estimate=0.065, P<0.01), OAHI (parameter estimate=-0.023, P<0.01), oxygen desaturation index (parameter estimate=-0.019, P<0.01), respiratory related arousal index (parameter estimate=-0.031, P<0.01), and oxygen saturation nadir (parameter estimate=0.067, P=0.045). The relationship between BMI Z-score and RHI was quadratic. Multivariate regression analysis showed that age (parameter estimate=0.015, P<0.01), BMI Z-score (parameter estimate=0.040, P<0.01), BMI Z-score quadratic form (parameter estimate=-0.010, P<0.01), respiratory related arousal index (parameter estimate=-0.020, P<0.01) were independently correlated with RHI. Conclusions: Children with OSAS have significant endothelial dysfunction compared with PS. Frequent arousals due to obstructive respiratory events during sleep may be a candidate risk factor for endothelial dysfunction in children with OSAS.