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.

Problems and Countermeasures to Improve Clinical Trial Participants’Compensation Rights in China

Objective To discuss the problems existing in the compensation of Chinese clinical trial participants and propose some suggestions for improving their rights.Methods The literature related to the participants’right to compensation at home and abroad was searched to study the inadequacy of the compensation right for clinical trial participants in China from four aspects:insurance system,principle of attribution,legal relationship and compensation regulations.Then,some suggestions to improve the participants’right to compensation were proposed.Results and Conclusion China lacks clear legal norms for participants’right to compensation.There are problems such as unclear insurance rules and compensation rules,unclear contractual relationships between parties to clinical trials,and no laws and regulations to rely on for attribution and compensation.China should issue regulatory guidelines related to the right to compensation of participants in clinical trials,so that all parties in clinical trials can have rules to follow if there is the occurrence of injury,which can better protect the rights and interests of the participants.

RNA-seq analysis identified hormone-related genes associated with prognosis of triple negative breast cancer

Triple negative breast cancer(TNBC) is an aggressive subtype of breast cancer that currently lacks effective biomarkers and therapeutic targets required to investigate the diagnosis and treatment of TNBC. Here we performed a comprehensive differential analysis of 165 TNBC samples by integrating RNA-seq data of breast tumor tissues and adjacent normal tissues from both our cohort and The Cancer Genome Atlas(TCGA). Pathway enrichment analysis was conducted to evaluate the biological function of TNBC-specific expressed genes. Further multivariate Cox proportional hazard regression was performed to evaluate the effect of these genes on TNBC prognosis. In this report, we identified a total of 148 TNBC-specific expressed genes that were primarily enriched in mammary gland morphogenesis and hormone levels related pathways, suggesting that mammary gland morphogenesis might play a unique role in TNBC patients differing from other breast cancer types. Further survival analysis revealed that nine genes(FSIP1, ADCY5, FSD1, HMSD, CMTM5, AFF3, CYP2 A7, ATP1 A2,and C11 orf86) were significantly associated with the prognosis of TNBC patients, while three of them(ADCY5,CYP2 A7, and ATP1 A2) were involved in the hormone-related pathways. These findings indicated the vital role of the hormone-related genes in TNBC tumorigenesis and may provide some independent prognostic markers as well as novel therapeutic targets for TNBC.

Implementation of Resilience Engineering for Thoracic Surgery. Reconciling Work-as-Imagined and Work-as-Done

Background: The Work-As-Imagined (WAI) is a plan that is expected to be performed before surgery, and the Work-As-Done (WAD) is the result of work actually done. In order to perform safe and high-quality surgery for the individual surgeon, the surgical team, and hospital organization as a system, we have to reconcile the WAI and the WAD in resilience engineering for the real world of surgical healthcare. Objective: Based on the resilient healthcare theory, we would like to clarify the actual way of reconciling the WAI and WAD in surgery. Material and Methods: As a typical model of thoracic surgery, we use a lobectomy case for lung cancer. We describe a surgeon’s WAI and WAD, and we explain the anticipating, monitoring, responding, and learning based on the resilient healthcare theory. We reveal the gaps between the WAI and WAD during an operation, we consider the surgeon’s thinking and actual performance, and we describe the actual way of reconciling the WAI and WAD for the surgeon and surgical team. Outcomes: We described three scenes in the operating room, which are 1) by individual surgeon: adjustment for intrathoracic adhesion;2) by surgical team: adjustment for pulmonary artery bleeding;and 3) by surgical team with multi-professionals in the operating room: adjustment for life threatening pulmonary artery critical bleeding. Conclusion: In order to implement a resilient healthcare theory in everyday surgical work, it is important that 1) learning of incidents and the experience of doing well for unexpected events as lessons, and 2) constructing a circulation mechanism of anticipating, monitoring, responding, and learning.

Implementation of Resilience Engineering for Operating Room. Unveiling the Hidden Interactions among Multi-Professionals in a Surgical Team

Background: The implementation of resilience engineering for an operating room is difficult;however, its study would become important for the surgeon’s personal and surgical team in order to develop a new surgical safety management. An expert operator must perform an operation with his surgical team that includes an anesthetist, scrub nurse, and young assistant. However, there exist some gaps among these multi-professionals. Objective: From the viewpoint of an expert operator, to have an operation go well, we would describe how to reconcile their gaps. We will explain the gaps among the multi-professionals in a surgical team, such as hidden interactions between the operator and anesthetist, surgeon and scrub nurse, and expert operator and young assistant. Material and Methods: We assumed three types of interactions among the multi-professionals in the operating theater and we clarified how to bridge the gaps by revealing what the operator thinks, what the anesthetist thinks, what the scrub nurse thinks, and what the young assistant thinks in the surgical team, and by understanding how they perform during surgery. Outcomes: What the expert operator thinks and how he performs in surgery is summarized by the following three items: 1) safety is first, 2) achieving the operative purpose, and 3) fast surgery. We interviewed the surgical team members. In order for the surgery to go well, what the important thing is “safety first” for any surgical professionals. The sentence, “safety is first” is the magic words, such as “open sesame”. They can communicate with each other on the spot and build the team and system. To develop a strong and resilient surgical team, these four behaviors are important to improve the performance as a system: 1) sharing the same goal and same priority, 2) understanding gaps with clear verbal communication. Coming out from own professional boundaries (takotsubo), speaking in words, 3) all of us, having a strong will (iron heart), and learning anger management, and 4) improvising even in difficult situations. Conclusion: We would like to summarize the items learned from my three described scenes, which are 1) to develop a strong and resilient surgical team, 2) what we have to do, and how we have to perform, and 3) how we can develop a team and system.

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.

Mortality and Morbidity Following Surgery for Primary Malignant Musculoskeletal Tumors in the Pelvis and Limbs: A Retrospective Analysis Using the Japanese Diagnosis Procedure Combination Database

Introduction: Resection of malignant pelvic tumors has long been considered to be associated with higher postoperative mortality and morbidity than resection of malignant limb tumors. We compared the postoperative adverse events of pelvic tumor surgery and limb tumor surgery using a national inpatient database. Methods: We identified patients who underwent surgery for primary musculoskeletal malignant tumors of the pelvis or limbs between July and December in 2007- 2010 using the Japanese Diagnosis Procedure Combination inpatient database. We calculated the risk-adjusted odds ratio for the occurrence of postoperative complications following pelvic tumor surgery with reference to limb tumor surgery using a multivariable logistic regression analysis. Results: Of 3255 eligible patients, 3116 underwent limb tumor surgery and 139 underwent pelvic tumor surgery. In-hospital mortality was 0.6% and 0.7% and postoperative complication rates were 8.2% and 18.7%, respectively. The rate of blood transfusion and duration of anesthesia over 480 min were higher in the pelvic tumor group. Blood transfusion volume and duration of anesthesia were independently associated with worse outcomes, but there was no significant association between tumor location and occurrence of postoperative complications (odds ratio 1.18, 95% confidence interval 0.73 - 1.88, p = 0.502). Conclusions: Blood transfusion volume and duration of anesthesia were significant predictors of outcome. Our data demonstrate that the higher morbidity rate after pelvic tumor resection could result from the larger blood transfusion volume and longer anesthesia duration.

Risk Factors Associated with In-Hospital Post-Chemotherapy Mortality in Patients with Malignant Musculoskeletal Tumors

Introduction: Reducing the in-hospital post-chemotherapy mortality rate in patients with malignant musculoskeletal tumors is important for improving treatment outcome. This study aimed to investigate the risk factors associated with in-hospital post-chemotherapy mortality in patients with primary malignant musculoskeletal tumors. Methods: Using a Japanese national inpatient database, we retrospectively identified 5039 patients (2920 men and 2131 women;mean age, 39 years) who underwent curative chemotherapy for malignant musculoskeletal tumors between 2007 and 2010. We extracted data on the patients’ characteristics, complications, chemotherapeutic agent use, comorbidities, and in-hospital death. Logistic regression analyses were performed to analyze factors affecting in-hospital post-chemotherapy death in these patients. Results: The overall in-hospital mortality rate was 1.1%. Higher in-hospital mortality rates were significantly associated with a greater volume of blood transfusion (>2500 mL) (odds ratio [OR], 49.71;95% confidence interval [CI], 22.24 - 111.12;p < 0.001), diabetes mellitus (OR, 3.05;95% CI: 1.21 - 7.70;p = 0.019), and older age (OR, 3.05;95% CI, 1.11 - 8.37;p = 0.031). Conclusions: Higher in-hospital post-chemotherapy mortality rates were associated with massive blood transfusion, which was associated with a 16-fold higher risk of in-hospital mortality compared with other risk factors. Blood transfusion volume should be considered an important indicator for deciding whether the next cycle of chemotherapy is administered continuously or not.

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.

Consensus by Chinese Expert Panel on Chlamydia trachomatis-Resistant and Chlamydia trachomatis-Persistent Infection

Chlamydia trachomatis （Ct） genital infection is the most common sexually transmitted disease （STD） in China and the US. The morbidity of Ct genital infection in China has increased from 32.48/100,000 in 2008 to 37.18/100,000 in 2015.[1] The major areas of Ct infections are concentrated in the Zhujiang Delta, Changjiang Delta, Minjiang Area, and West China. In these areas, the highest incidence of Ct infection reaches 615.99/100,000 citizens. In the US, there are 1,441,789 reported Ct, which include 627.2 females and 278.4 males per 100,000 population. It is now the most prevalent STD, with its rate increasing to 22% in males and 6% in females.[2] Ct genital infection can cause epididymitis, prostatitis, cervicitis, annexitis, infertility, and atopic pregnancy, which have been identified as the major public health problems.

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).