Diagnostic values of questionnaires of Convergence Insufficiency Symptom Survey and College of Optometrists Vision Development Quality of Life in the screening of convergence insufficiency

AIM:To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire(COVD-QOL)and the Convergence Insufficiency Symptom Survey(CISS)in detecting convergence insufficiency and to compare their diagnostic value in clinical applications.METHODS:Using the diagnostic test method,62 adult patients with convergence insufficiency(age:24.74±3.75y)and 62 normal participants(age:23.61±3.13y)who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included.All subjects completed the CISS and COVD-QOL.Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed.RESULTS:The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5%and 71.0%,respectively,while the specificity was 96.8%and 67.7%,respectively.Compared to the CISS alone,the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity.The areas under the receiver operating characteristic curve of CISS,COVD-QOL and CISS combined with COVD-QOL were 0.806,0.694 and 0.782,respectively.CONCLUSION:Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL,it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.

Effect of vinegar supplementation on patients with esophageal lesions lightly stained with Lugol’s iodine solution:Prospective single-centre trial

BACKGROUND Esophageal chromoendoscopy with iodine solution is important for detecting early esophageal cancer.The effect of routine treatment for lesions lightly stained with Lugol’s iodine solution is limited,and the addition of natural substances to a regular diet is becoming increasingly common.Vinegar has antitumor effects as reported in previous studies.AIM To evaluate whether vinegar supplementation could improve the prognosis of patients with lightly stained esophageal lesions.METHODSThis prospective single-centre trial included consecutive patients with lightly stained lesions between June 2020 and April 2022.Patients in the experimental group received increased amounts of vinegar for 6 months.The primary outcome of the study was the clinical therapeutic effect.Complications related to vinegar ingestion and adverse events were also recorded in detail.RESULTS A total of 166 patients were included in the final analysis.There was no significant difference in the baseline data between the two groups.Intention-to-treat(ITT)analysis demonstrated that the rates at which endoscopic characteristics improved were 33.72%in the experimental group and 20.00%in the conventional group(P=0.007);and the rates at which biopsy pathology improved were 19.77%and 8.75%,respectively(P=0.011).Additional vinegar consumption had a statistically protective effect on the rate at which endoscopic characteristics improved[hazard ratio(HR)_(ITT)=2.183,95%CI:1.183-4.028;HR_(per-protocol(PP))=2.307,95%CI:1.202-4.426]and biopsy pathology improved(HR_(ITT)=2.931,95%CI:1.212-7.089;HR_(PP)=3.320,95%CI:1.295-8.507).No statistically significant effect of increased vinegar consumption on preventing high-grade intraepithelial neoplasia or early cancer was observed(HR_(ITT)=0.382,95%CI:0.079-1.846;HRPP=0.382,95%CI:0.079-1.846).The subgroup analyses indicated that the overall therapeutic improvement of endoscopic characteristics and biopsy pathology seemed more obvious in older(age>60)male patients with small lesions(lesion size≤0.5 cm).Three patients in the experimental group reported acid regurgitation and heartburn.No adverse event during gastroscopy were recorded during follow-up.CONCLUSION A moderately increased ingestion of vinegar could not directly reduce the risk of esophageal cancer in the mucosa dysplasia population,but it improved the endoscopic characteristics and ameliorated the biopsy pathology to a certain extent.Further research is needed to verify the effect of nutritional intervention on precancerous esophageal lesions.

Frequency and risk factors of psychological distress among individuals with epilepsy before and during the outbreak of the SARS-CoV-2 Omicron variant in China:an online questionnaire survey

Background The COVID-19 pandemic substantially increases the risk of severe psychological distress among people with epilepsy(PWE),especially those with monthly household income<5000 RMB or with uncontrolled seizures.Patients with Kessler scores>12 should consult a psychiatrist,especially during major disasters.This study was aimed to compare the frequency of psychological distress among Chinese PWE before and during the outbreak of the SARS-CoV-2 Omicron variant,and to identify risk factors for such distress.Methods In this prospective study,we collected sociodemographic data of PWE aged>14 years,who were treated at our center during December 1 to 15,2022.All participants completed the 6-item Kessler Psychological Distress Scale before the outbreak and again during the outbreak.Health visitors who were unrelated to those patients during the outbreak were included as a control.Multivariate logistic regression analysis was performed to identify risk factors of severe psychological distress and its exacerbation.Results Of the 223 PWE,127 were tested positive for SARS-CoV-2,while 174 of 218 controls were positive for SARS-CoV-2.The neurological symptoms were similar between PWE and controls with SARS-CoV-2.The average Kessler score of PWE was significantly higher during the outbreak than before it(9.93±3.98 vs.8.52±0.23,P<0.001).The average score of controls during the outbreak(5.146±0.35,P<0.001)was significantly lower than that of the PWE.We identified three independent predictors for severe psychological distress in PWE during the outbreak,i.e.,monthly household income<5000 RMB(OR=0.252,95%CI 0.064–0.998,P=0.048),severe psychological distress before the outbreak(OR=0.067,95%CI 0.026–0.174,P<0.001),and seizure onset within 30 days before the assessment during the outbreak(OR=0.356,95%CI 0.157–0.805,P=0.013).Of the three predictors,the last one was also an independent predictor for exacerbation of psychological distress during the outbreak(OR=0.302,95%CI 0.123–0.741,P=0.009).Conclusions Our analysis suggests that the COVID-19 pandemic has substantially increased psychological distress of individuals with epilepsy,regardless of the viral infection or not.Various neurological symptoms similar to those of“long COVID”appeared for the first time among these individuals during the Omicron outbreak,highlighting the need for clinicians to screen carefully for this condition.Management of epilepsy during the pandemic or a similar major disaster should focus on the control of seizures and maintenance of mental health,especially among those with monthly household incomes below 5000 RMB,suffering uncontrolled seizures and having a history of severe psychological distress.

Disease awareness and dietary habits of patients with epilepsy in western China:a cross-sectional study

Background:The optimal management of epilepsy includes engaging patients through education on knowledge of the disease,its treatment and diet control.Methods:This was a cross-sectional survey-based cohort study,aimed to investigate the awareness of epilepsy in Chinese patients and to understand their dietary habits.Participants were consecutively enrolled from epileptic patients treated in a single epilepsy center from October 1,2019 to February 29,2020.A self-reported questionnaire(Cronbach’sα=0.758)consisting of 3 parts was sent to 407 patients with epilepsy.The questionnaire included items on demographic information,epilepsy features,awareness of epilepsy treatment and dietary habits.Results:About half of the patients(53.8%,219/407)thought epilepsy was curable and only 80%knew that the first choice of treatment is medication.While 58.6%of the patients with low educational level preferred the use of antiepileptic drugs(p=0.014),52.7%believed that the medication should not be stopped immediately after seizure control(p=0.026),especially after surgery(40.5%,p=0.011).Patients with lower household monthly incomes had less awareness of the use of antiepileptic drugs than patients with higher incomes:only 39.2 and 49.8%of patients with lower incomes thought that the drugs could be stopped after epilepsy surgery or seizure control,respectively,compared to 51.6 and 66.1%with higher incomes.Alcohol(86.2%),caffeine(56.8%)and strong tea(49.1%)were top three foods considered by the patients to be avoided to prevent seizures.Approximately 30.2%of patients identified at least one food that made them susceptible to seizures.Conclusions:Patient education on epilepsy,antiepileptic drugs and diet for management of seizures should be provided especially to patients with less education,lower income or inaccurate beliefs of epilepsy in Western China.

The association between heavy metal exposure and erectile dysfunction in the United States

Literature regarding the impacts of heavy metal exposure on erectile dysfunction(ED)is scarce.We aimed to evaluate the correlation between 10 urinary metals and ED in a large,nationally representative adult male sample.The dataset was extracted from the National Health and Nutrition Examination Survey(NHANES)during the period of 2001–2002 and 2003–2004.Weighted proportions and multivariable logistic regression analysis adjusted for confounding variables were utilized to determine the relationship between metal exposure and ED.Weighted quantile sum(WQS)regression was utilized to evaluate the impact of a mixture of urinary metals on ED.A total of 1328 participants were included in our study.In multivariable logistic regression analysis,cobalt(Co)and antimony(Sb)were positively associated with ED(odds ratio[OR]:1.36,95%confidence interval[CI]:1.10–1.73,P=0.020;and OR:1.41,95%CI:1.12–1.77,P=0.018,respectively)after full adjustment.Men in tertile 4 for Co(OR:1.49,95%CI:1.02–2.41,P for trend=0.012)and Sb(OR:1.53,95%CI:1.08–2.40,P for trend=0.041)had significantly higher odds of ED than those in tertile 1.Furthermore,the WQS index was significantly linked with increased odds of ED after full adjustment(OR:1.31,95%CI:1.04–1.72,P<0.05).Our study expanded on previous literature indicating the possible role of heavy metal exposure in the etiology of ED.The evaluation of heavy metal exposure should be included in the risk assessment of ED.

Does the homologous booster with the inactivated coronavirus disease 2019 vaccine work for the omicron variant?Real-world evidence from Jilin,China

To the Editor:The latest variant of concern,Omicron,has become the dominant global variant immediately after it was first reported in November 2021.[1]It contains>30 mutations in the spike protein,with 17 mutations in the receptor-binding domain,rendering it with increased transmissibility and capacity for immune evasion.[1,2]Moreover,the waning of protection has been observed over time since the coronavirus disease 2019(COVID-19)vaccination.[3]Therefore,a booster is highly recommended.A large-scale study in the UK assessing the effectiveness of the booster vaccination with either the BNT162b2 or mRNA-1273 indicated that the booster shot substantially increased protection against symptomatic infection in patients with the confirmed Omicron variant infection.[3]However,although the laboratory study has illustrated that the homologous booster with the inactivated COVID-19 vaccine could also yield potent neutralizing activity against the Omicron variant,[4]clinical evidence regarding the effectiveness of this vaccination program is limited.

Immunotherapy in non-small cell lung cancer:rationale,recent advances and future perspectives

Lung cancer,with non-small cell lung cancer(NSCLC)being the major type,is the second most commonmalignancy and the leading cause of cancer-related death globally.Immunotherapy,represented by immune checkpoint inhibitors(ICIs),has been one of the greatest advances in recent years for the treatment of solid tumors including NSCLC.However,not all NSCLC patients experience an effective response to immunotherapy with the established selection criteria of programmed death ligand 1(PD-L1)and tumor mutational burden(TMB).Furthermore,a considerable proportion of patients experience unconventional responses,including pseudoprogression or hyperprogressive disease(HPD),immune-related toxicities,and primary or acquired resistance during the immunotherapy process.To better understand the immune response in NSCLC and provide reference for clinical decision-making,we herein review the rationale and recent advances in using immunotherapy to treat NSCLC.Moreover,we discuss the current challenges and future strategies of this approach to improve its efficacy and safety in treating NSCLC.

Maternally inherited H4K16 acetylation primes zygotic gene activation in Drosophila

In a recent study published in Cell, Samata et al. demonstrated a novel mechanism that guided the genomic reprogramming. They showed that the acetylation of histone H4 at Lysine 16(H4K16ac) was intergenerationally maintained from the mother’s oocyte to the young embryo and primed zygotic gene activation in Drosophila(Samata et al., 2020).Embryonic development is initially directed by maternal gene products. Then gradually, developmental control is handed to the zygotic genome during the maternal-to-zygotic transition(MZT).