[Ultrasonographic features of retinal pigment epithelial adenoma]

Objective: To investigate the ultrasonographic features of retinal pigment epithelium (RPE) adenoma. Methods: It was a retrospective case series study. The clinical clata of 15 patients (15 eyes) with pathologically confirmed RPE adenoma after local resection of intraocular tumor was collected at Beijing Tongren Hospital, Capital Medical University from November 2013 to October 2019. The general conditions of the patients and the location, size, shape, internal echo features of the lesions in the ocular ultrasound sonogram were analyzed, and the blood flow in the lesions was checked by color Doppler flow imaging (CDFI). Results: Of all the patients included in the study, 7 were male and 8 were female. Their age ranged from 25 to 58 years, with a mean age of (45.7±10.2) years. The most common symptom was vision loss or blurred vision (11 cases). Other symptoms included dark shadows or obscuration in front of the eyes (3 cases) and no symptoms (1 case). A history of previous ocular trauma was present in one case, and the rest of the patients had no history of ocular trauma.The location of tumor growth is scattered. The ultrasonographic features were as follows: the average maximum basal diameter was (8.07±2.75) mm and the average height was (4.02±1.81) mm; the ultrasonographic features mostly demonstrated abruptly elevated dome-shaped echo (6 cases); the lesion edge was not smooth, the internal echo was medium or low, and there could be hollow features (2 cases), with no choroidal depression; and the blood flow signal could be seen in the CDFI lesion, which could lead to retinal detachment and vitreous opacification. Conclusion: The ultrasound imaging features of RPE adenomas mostly demonstrate abruptly elevated dome-shaped echo, unsmooth lesion edge, with no choroidal depression, which may provide valuable evidence for clinical diagnosis and differentiation.

[Related factors of negative conversion time of nucleic acid in children with COVID-19]

Objective: To explore the related factors of negative conversion time (NCT) of nucleic acid in children with COVID-19. Methods: A retrospective cohort study was conducted. A total of 225 children who were diagnosed with COVID-19 and admitted to Changxing Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 3^rd to May 31^st 2022 were enrolled in the study. The infection age, gender, viral load, basic disease, clinical symptoms and information of accompanying caregivers were retrospectively analyzed. According to age, the children were divided into<3 years of age group and 3-<18 years of age group. According to the viral nucleic acid test results, the children were divided into positive accompanying caregiver group and negative accompanying caregiver group. Comparisons between groups were performed using Mann-Whitney U test or Chi-square test. Multivariate Logistic regression analysis was used to analyze the related factors of NCT of nucleic acid in children with COVID-19. Results: Among the 225 patients (120 boys and 105 girls) of age 2.8 (1.3, 6.2) years, 119 children <3 years and 106 children 3-<18 years of age, 19 cases were diagnosed with moderate COVID-19, and the other 206 cases were diagnosed with mild COVID-19. There were 141 patients in the positive accompanying caregiver group and 84 patients in the negative accompanying caregiver group.Patients 3-<18 years of age had a shorter NCT (5 (3, 7) vs.7 (4, 9) d, Z=-4.17, P<0.001) compared with patients <3 years of age. Patients in the negative accompanying caregiver group had a shorter NCT (5 (3, 7) vs.6 (4, 9) d,Z=-2.89,P=0.004) compared with patients in the positive accompanying caregiver group. Multivariate Logistic regression analysis showed that anorexia was associated with NCT of nucleic acid (OR=3.74,95%CI 1.69-8.31, P=0.001). Conclusion: Accompanying caregiver with positive nucleic acid test may prolong NCT of nucleic acid, and decreased appetite may be associated with prolonged NCT of nucleic acid in children with COVID-19.

[Interpretation of the European Federation of Periodontology S3 level clinical practice guideline for treatment of stage Ⅳ periodontitis]

The S3 level clinical practice guideline for the treatment of stage Ⅳperiodontitis, developed by the European Federation of Periodontology, was published in April 22, 2022 (DOI: 10.1111/jcpe.13639). According to the severity and complexity, stage Ⅳ periodontitis was grouped into four case types, and comprehensive treatment plans were formulated correspondingly in the guideline, including tooth splinting, occlusal adjustment, orthodontic therapy, restorative therapy, and personalized supportive periodontal care as well. The aim of present work is to intensively interpret the key points of the guideline and help the clinicians to understand this guideline better, in order to improve the treatment level of stage Ⅳ periodontitis in China.

[Clinical characteristics of 18 children with chronic nonbacterial osteomyelitis]

Objective: To investigate the clinical features of children with chronic nonbacterial osteomyelitis (CNO), and raise awareness among clinicians. Methods: In this retrospective study, 18 patients with CNO who were diagnosed in Children's Hospital of Fudan University from January 2015 to December 2021 were included. Results: Eighteen children with CNO (12 males, 6 females) were identified. Their age at onset was 9 (5, 11) years, the delay in diagnosis was 2 (1, 6) months, and follow-up-was 17 (8, 34) months. The most common symptoms were fever in 14 children, as well as bone pain and (or) arthralgia in 14 children. In terms of laboratory results, normal white blood cell counts were observed at onset in 17 patients; increased erythrocyte sedimentation rate (ESR) in all patients; increased C reactive protein (CRP) over the normal value in 14 patients. Of the 18 patients, 2 had positive antinuclear antibodies, while none had positive human leukocyte antigen-B27 or rheumatoid factor. Imaging examination revealed that all the patients had symmetrical and multifocal skeletal lesions. The number of structural lesions detected by imaging investigation was 8 (6, 11). The most frequently affected bones were tibia in 18 patients and femur in 17 patients. Bone biopsy was conducted in 14 patients and acute or chronic osteomyelitis manifested with inflammatory cells infiltration were detected. Magnetic resonance imaging (MRI) found bone lesions in all the patients and bone scintigraphy were positive in 13 patients. All the patients were treated with nonsteroidal anti-inflammatory drugs, among whom 10 cases also treated with oral glucocorticoids, 9 cases with traditional disease modifying anti-rheumatic drugs, 8 cases with bisphosphonates and 6 cases with tumor necrosis factor inhibitors. The pediatric chronic nonbacterial osteomyelitis disease activity score, increased by 70% or more in 13 patients within the initial 6-month follow-up. Conclusions: The clinical manifestations of CNO are lack of specificity. The first symptom of CNO is fever, with or without bone pain and (or) arthralgia, with normal peripheral blood leukocytes, elevated CRP and (or) ESR. Whole body bone scanning combined with MRI can early detect osteomyelitis at subclinical sites, and improve the diagnostic rate of CNO.

[Research progress and clinical application value of exosomal circRNAs in hepatocellular carcinoma]

Primary liver cancer (hereinafter referred to as HCC) is the sixth most common type of cancer and the third leading cause of cancer-related mortality worldwide. Since patients in the early stage of HCC are typically asymptomatic and there are currently no specific detection methods for the early stage of HCC, the majority of patients are diagnosed in the late stage. Exosomes carry proteins, non-coding RNAs, such as cyclic RNAs (circRNAs), and other biological molecules. Patients with hepatocellular carcinoma have a higher concentration of serum exosomes than healthy individuals, and the circRNAs in the exosomes can reflect the source cells and real-time disease status, suggesting it has the potential to detect liver cancer early. This paper focuses on the latest progress of exosomal circRNAs and analyzes the potential value of exosomes in the early diagnosis, treatment, and progression of HCC.

[Analysis of epidemiological characteristics of bacillary dysentery with multiple-onset in Henan Province from 2005 to 2020]

Objective: To understand the epidemiological characteristics of bacillary dysentery with multiple-onset in Henan province from 2005 to 2020. Methods: The reported cases of bacillary dysentery (including confirmed cases and clinically diagnosed cases) in Henan Province from January 2005 to December 2020 were collected through China's National Disease Supervision Information Management System. The main information included gender, age, home address, date of onset and date of diagnosis. The interval between two episodes of the same case was more than 15 days, which was judged as two episodes. The incidence characteristics of bacillary dysentery patients with two or more cases in Henan Province from 2005 to 2020 were analyzed, and the regional distribution map of cases was drawn using ArcGIS software. Results: From 2005 to 2020, a total of 250 430 cases of bacillary dysentery were reported in Henan Province, with a cumulative incidence rate of 228.66/100 000. There were 2 342 cases with two or more attacks. The incidence of recurrent cases of bacillary dysentery increased year by year (χ²_trend=2 932.28, P<0.001). There was no significant difference in the incidence of two or more cases of different sexes (χ²=0.39, P=0.540). There was significant difference in the incidence among different age groups (χ²=438.40, P<0.001). The incidence of two or more cases in the 60-69 age group was relatively high (1.70%). The shortest time interval between the onset of the disease was 16 days, and the longest was 5 579 days, with M (Q₁, Q₃) about 428 (237, 843) days. Compared with healthy people, those with a history of bacterial diseases had a higher risk of developing bacillary dysentery (RR: 4.12, 95%CI: 3.95‒4.29). Conclusion: The proportion of patients with multiple-onset shows an increasing trend, and there is an age difference.

Accurate elemental analysis with variant one-point calibration laser-induced breakdown spectroscopy capable of using analytical lines with unknown transition probabilities

Calibration-free laser-induced breakdown spectroscopy (CF-LIBS) is a very useful elemental analysis technique. However, it requires knowledge of transition probabilities of the analytical lines. To solve this problem, a variant one-point calibration (OPC) LIBS method was proposed. Quantitative elemental analysis on Cu-Zn-Ag-Au alloys was realized with this method capable of using zinc analytical lines with unknown transition probabilities. The relative error was demonstrated to be less than 3.3%. This variant OPC method will be helpful for quantitative elemental analysis of different samples using CF-LIBS, no matter whether the transition probabilities of the observed lines are known or unknown.

[Clinical characteristics of 272 437 patients with different histopathological subtypes of primary esophageal malignant tumors]

Objective: To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT). Methods: A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ² test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results: A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment. Conclusion: ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

First Measurement of High-Energy Reactor Antineutrinos at Daya Bay

This Letter reports the first measurement of high-energy reactor antineutrinos at Daya Bay, with nearly 9000 inverse beta decay candidates in the prompt energy region of 8-12 MeV observed over 1958 days of data collection. A multivariate analysis is used to separate 2500 signal events from background statistically. The hypothesis of no reactor antineutrinos with neutrino energy above 10 MeV is rejected with a significance of 6.2 standard deviations. A 29% antineutrino flux deficit in the prompt energy region of 8-11 MeV is observed compared to a recent model prediction. We provide the unfolded antineutrino spectrum above 7 MeV as a data-based reference for other experiments. This result provides the first direct observation of the production of antineutrinos from several high-Q_{β} isotopes in commercial reactors.

[Decoding the evolution of preventive chemotherapy schemes for schistosomiasis in China to improve the precise implementation of the WHO guideline on control and elimination of human schistosomiasis]

Preventive chemotherapy is one of the pivotal interventions for the control and elimination of schistosomiasis, which is effective to reduce the morbidity and prevalence of schistosomiasis. In order to promote the United Nations' sustainable development goals and the targets set for schistosomiasis control in the Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030, WHO released the guideline on control and elimination of human schistosomiasis in 2022, with major evidence-based updates of the current preventive chemotherapy strategy for schistosomiasis. In China where great success has been achieved in schistosomiasis control, the preventive chemotherapy strategy for schistosomiasis has been updated several times during the past seven decades. This article reviews the evolution of the WHO guidelines on preventive chemotherapy and Chinese national preventive chemotherapy schemes, compares the current Chinese national preventive chemotherapy scheme and the recommendations for preventive chemotherapy proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, and proposes recommendations for preventive chemotherapy during the future implementation of the 2022 WHO guideline, so as to provide insights into schistosomiasis control among public health professionals engaging in healthcare foreign aid.

[Follow-up study of fetal cardiac birth defects after prenatal diagnosis and graded counseling]

Objective: To explore accurate prenatal diagnosis, full-coverage graded counseling and follow-up for the fetus with cardiac birth defects (CBD). Methods: CBD fetus diagnosed prenatal by echocardiography from January 2018 to December 2020 in Guangdong Provincial People's Hospital were enrolled. Fetal CBD was graded (Ⅰ-Ⅵ) according to prognosis and possible operation time after birth, and the classification criteria and common diseases included were proposed. After the prenatal grading counseling, the outcome of the fetus was followed-up. The induced labor rate, live birth rate, prenatal and postnatal ultrasound diagnosis coincidence rate and other indicators were calculated. The disease composition ratio, prognosis of fetus with different grades and the outcome of integrated treatment were analyzed. Results: The detection rate of fetal CBD was up to 16.2% (1 971/12 188), 30 cases of which were excluded. A total of 1 941 cases were included in this study, including 196 cases (10.1%) of gradeⅠ, 433 cases (22.3%) of gradeⅡ, 615 cases (31.7%) of grade Ⅲ, 261 cases (13.4%) of grade Ⅳ, 388 cases (20.0%) of gradeⅤ, 48 cases (2.5%) of grade Ⅵ. Grade Ⅱ and gradeⅢ (the operation time was within 1 year after birth) accounted for 54.0% (1 048/1 941). The distribution of some diseases in different grades had obvious proportion advantage, which was representative. Among 1 747 CBD fetus, 736 cases (induced labor rate 42.1%) chose to terminate pregnancy due to CBD. Of the 1 010 live births, 975 cases (96.5%) had the same prenatal and postnatal diagnosis, 3 cases were missed diagnosis and 32 cases were misdiagnosed. The diagnostic accuracy of live births with severe and complex congenital heart disease was 383 out of 389 (98.5%). A total of 258 cases have received surgery or intervention. The age at the time of surgery or intervention was different among grades（χ²=47.3，P<0.001）. With the improvement of prognosis from gradeⅠ to Ⅴ, the live birth rate increased and the induced labor rate decreased accordingly; the difference between grades was significant（χ²=623.6，P<0.001）. Conclusions: Prenatal diagnosis and graded counseling is important in the integrated model. Fetal CBD grading could refine post-natal treatment strategies, guide delivery decisions and become an evaluation standard.

Sirolimus treatment for tuberous sclerosis complex prior to epilepsy: Evidence from a registry-based real-world study

OBJECTIVE

To evaluate whether sirolimus treatment could relieve the later burden of new-onset seizures in patients with tuberous sclerosis complex (TSC) prior to epilepsy.

METHODS

A real-world matched case-control study was nested in another registry cohort study. Infants with TSC (<12 months old) without seizures whose parents agreed on sirolimus treatment for other symptoms were eligible for inclusion to the early sirolimus (ES) group. These patients were enrolled from 2015 to 2018. Controls in the late sirolimus (LS) group were matched from the registry cohort database for 2015-2018. Age and genotype were used as the initial stratifying criteria and other symptoms as the greedy matching criteria at a matching ratio of 1:4. None of the preventive drugs were introduced before seizure onset or before 2 years of age in the LS group. Both groups were followed up until June 2020. The primary objective was a comparison of the characteristics of the first seizure between the two groups. The secondary objective was the assessment of the final seizure status at the endpoint.

RESULTS

There were 42 and 168 patients with TSC in the ES and LS groups, respectively. Early sirolimus treatment significantly reduced the seizure onset, especially in the patients aged <6 months. The mean onset-age was significantly delayed by sirolimus treatment (11.34±7.93 months vs. 6.94±6.03 months, P<0.001). The subtype of seizures that benefited the most was spastic (onset) seizures (all were infantile spasms) [5/42 (11.90%) vs. 73/168 (43.45%), P<0.001]; these seizures were either eliminated or alleviated. The sirolimus treatment addition prior to seizures was more effective than its addition after seizures in reducing drug-resistant epilepsy [10/42 (23.81%) vs. 70/147 (47.62%), P=0.004].

CONCLUSION

Early sirolimus treatment for TSC effectively modified the disease by preventing infantile spasms, delaying seizure onset, and relieving its severity. The anti-epileptogenic effect of sirolimus may be time- and dose-dependent.

Joint Determination of Reactor Antineutrino Spectra from ^{235}U and ^{239}Pu Fission by Daya Bay and PROSPECT

A joint determination of the reactor antineutrino spectra resulting from the fission of ^{235}U and ^{239}Pu has been carried out by the Daya Bay and PROSPECT Collaborations. This Letter reports the level of consistency of ^{235}U spectrum measurements from the two experiments and presents new results from a joint analysis of both data sets. The measurements are found to be consistent. The combined analysis reduces the degeneracy between the dominant ^{235}U and ^{239}Pu isotopes and improves the uncertainty of the ^{235}U spectral shape to about 3%. The ^{235}U and ^{239}Pu antineutrino energy spectra are unfolded from the jointly deconvolved reactor spectra using the Wiener-SVD unfolding method, providing a data-based reference for other reactor antineutrino experiments and other applications. This is the first measurement of the ^{235}U and ^{239}Pu spectra based on the combination of experiments at low- and highly enriched uranium reactors.

On summary ROC curve for dichotomous diagnostic studies: an application to meta-analysis of COVID-19

In a systematic review of a diagnostic performance, summarizing performance metrics is crucial. There are various summary models in the literature, and hence model selection becomes inevitable. However, most existing large-sample-based model selection approaches may not fit in a meta-analysis of diagnostic studies, typically having a rather small sample size. Researchers need to effectively determine the final model for further inference, which motivates this article to investigate existing methods and to suggest a more robust method for this need. We considered models covering several widely-used methods for bivariate summary of sensitivity and specificity. Simulation studies were conducted based on different number of studies and different population sensitivity and specificity. Then final models were selected using several existing criteria, and we compared the summary receiver operating characteristic (sROC) curves to the theoretical ROC curve given the generating model. Even though parametric likelihood-based criteria are often applied in practice for their asymptotic property, they fail to consistently choose appropriate models under the limited number of studies. When the number of studies is as small as 10 or 5, our suggestion is best in different scenarios. An example for summary ROC curves for chemiluminescence immunoassay (CLIA) used in COVID-19 diagnosis is also illustrated.

[Multimodal imaging analysis of the cyst like lesion of condyle in temporomandibular joint]

Objective: To investigate the imaging features of condylar cystic degeneration of temporomandibular joint (TMJ) by cone-beam CT (CBCT), spiral CT, MRI and radionuclide bone imaging. Methods: From January 2018 to December 2020, thirty-two patients with cyst-like lesions of condylein temporomandibular joint were examined by CBCT, spiral CT, MRI and radionuclide bone imaging at the Department of Oral and Maxillofacial Surgery in General Hospital of Chinese PLA. There were 12 males and 20 females involved, aged from 16 to 65 years with an average age of (33.9±12.5) years. The characteristics of CBCT, spiral CT, MRI and radionuclide bone imaging were analyzed. Condylar cyst like lesions were classified as type A and type B based on the presence or absence of surface bone defects. Condylar cyst like lesions were classified as type Ⅰ(yes) and type Ⅱ(no) according to the accompanying bone marrow edema-like lesions of the condyles. The incidence of condylar bone marrow edema, disc displacement and abnormal bone metabolism were analyzed. Results: A total of 64 joint images of 32 patients were included, including 34 sides with TMJ cyst-like lesion and 6 sides with multiple cyst-like lesions,the total cyst-like lesions were 42. The largest diameter of cyst-like lesion ranged from 1.0 to 12.4 mm, with an average length of (3.7± 1.8) mm. There were 24 cases of type A TMJ cyst like lesion and 10 cases of type B cyst-like lesion. The detection rate of CBCT was 95.2% (40/42) and that of spiral CT was 100% (42/42), there was no significant difference (Calibration Chi-square=0.51, P=0.474). The detection rate of nuclear magnetic resonance was 80.1% (34/42), and the detection rate of cyst-like lesions less than 2 mm was 3/11. In the cyst like lesion side, there were 9 sides with anterior disc displacement with reduction, 20 sides with anterior disc displacement without reduction. In the non-cyst like lesion side, 10 sides with anterior disc displacement with reduction and 6 sides with anterior disc displacement without reduction. There was a significant difference in the displacement of the disc between cyst-like and non-cystic lesion side (χ²=7.80, P=0.005). MRI showed that 6 cases of cystic side[17.6% (6/34)] had bone marrow edema-like lesions (all type A), 1 case of non-cyst like lesions side [3.3% (1/30)] had bone marrow edema-like lesion, there was no significant difference between cystic and non-cystic lesions (Calibration Chi-square=2.04, P=0.153). There was a significant difference between type A and B cystic lesions (Fisher exact probability method, P=0.024). Radionuclide bone imaging showed abnormal bone metabolism in 26 patients in the cyst-like lesion side and 5 patients in the non-cyst like lesion side (χ²=22.82, P<0.001). Conclusions Multi-slice Spiral CT could detect the cyst-like lesion of TMJ condyle in the early stage, which is different from the large joint. And the formation mechanism may vary from the different classifications.

[Research progress of dental pulp stem cells for peripheral nerve injury repair]

Peripheral nerve injuries are mainly related to severe trauma, fracture and tumor surgery, leading to reduced quality of life and impaired physical and mental health. The repair of peripheral nerve still faces great challenges in clinic, and the research on the regeneration and repair of peripheral nerve has become a hot issue in related disciplines. Cell therapy plays an irreplaceable role in tissue regeneration and repair. Schwann cells are ideal cells for peripheral nerve repair, but their limited sources inhibit the clinical application. Dental pulp stem cells are derived from neural crest, which provides a new cell source for nerve regeneration. The purpose of this article is to review the research progress of dental pulp stem cells for peripheral nerve repair.

[Multimodal imaging analysis of the cyst like lesion of condyle in temporomandibular joint]

Objective: To investigate the imaging features of condylar cystic degeneration of temporomandibular joint (TMJ) by cone-beam CT (CBCT), spiral CT, MRI and radionuclide bone imaging. Methods: From January 2018 to December 2020, thirty-two patients with cyst-like lesions of condylein temporomandibular joint were examined by CBCT, spiral CT, MRI and radionuclide bone imaging at the Department of Oral and Maxillofacial Surgery in General Hospital of Chinese PLA. There were 12 males and 20 females involved, aged from 16 to 65 years with an average age of (33.9±12.5) years. The characteristics of CBCT, spiral CT, MRI and radionuclide bone imaging were analyzed. Condylar cyst like lesions were classified as type A and type B based on the presence or absence of surface bone defects. Condylar cyst like lesions were classified as type Ⅰ(yes) and type Ⅱ(no) according to the accompanying bone marrow edema-like lesions of the condyles. The incidence of condylar bone marrow edema, disc displacement and abnormal bone metabolism were analyzed. Results: A total of 64 joint images of 32 patients were included, including 34 sides with TMJ cyst-like lesion and 6 sides with multiple cyst-like lesions,the total cyst-like lesions were 42. The largest diameter of cyst-like lesion ranged from 1.0 to 12.4 mm, with an average length of (3.7±1.8) mm. There were 24 cases of type A TMJ cyst like lesion and 10 cases of type B cyst-like lesion. The detection rate of CBCT was 95.2% (40/42) and that of spiral CT was 100% (42/42), there was no significant difference (Calibration Chi-square=0.51, P=0.474). The detection rate of nuclear magnetic resonance was 80.1% (34/42), and the detection rate of cyst-like lesions less than 2 mm was 3/11. In the cyst like lesion side, there were 9 sides with anterior disc displacement with reduction, 20 sides with anterior disc displacement without reduction. In the non-cyst like lesion side, 10 sides with anterior disc displacement with reduction and 6 sides with anterior disc displacement without reduction. There was a significant difference in the displacement of the disc between cyst-like and non-cystic lesion side (χ²=7.80, P=0.005). MRI showed that 6 cases of cystic side[17.6% (6/34)] had bone marrow edema-like lesions (all type A), 1 case of non-cyst like lesions side [3.3% (1/30)]had bone marrow edema-like lesion, there was no significant difference between cystic and non-cystic lesions (Calibration Chi-square=2.04, P=0.153). There was a significant difference between type A and B cystic lesions (Fisher exact probability method, P= 0.024). Radionuclide bone imaging showed abnormal bone metabolism in 26 patients in the cyst-like lesion side and 5 patients in the non-cyst like lesion side (χ²=22.82, P<0.001). Conclusions Multi-slice Spiral CT could detect the cyst-like lesion of TMJ condyle in the early stage, which is different from the large joint. And the formation mechanism may vary from the different classifications.

[ ≥ ]

Objective: To investigate the safety and efficacy of retroperitoneal laparoscopic selective renal artery branch occlusion with nephron sparing surgery in patients with renal carcinoma of stage ≥ T1b. Methods: From July 2016 to September 2020, 35 patients with renal cancer ≥T1b underwent retroperitoneoscopic nephron sparing surgery in the First Affiliated Hospital of Shenzhen University. The surgical methods were retroperitoneoscopic nephron sparing surgery with total renal artery occlusion (group A) or selective renal artery branch occlusion (group B). Operation time, heat ischemia time, blood transfusion rate, positive margin rate, intraoperative blood loss, postoperative complications and length of hospital stay were compared between the two groups, and the total glomerular filtration rate (GFR) and the single-nephron glomerular filtration rate (sGFR) of the offected kidneys were compared between the two groups before, 3 months after and 12 months after surgery. Results: Among the 35 patients, 19 were male and 16 were female, aged (55.7±8.4) years and the body mass index is (24.6±3.1) kg/m². The tumor diameter was (54.7±10.3) mm. The difference was statistically significant of operative time between group A and B [(103.5±14.3) vs (123.2±14.1) min,P=0.003]. There were no significant differences in thermal ischemia time, blood transfusion rate, positive margin, intraoperative blood loss, incidence of postoperative complications and length of hospital stay between the two groups (all P>0.05). The decrease of renal sGFR in the group A was significantly higher than group B at 3 months and 12 months after surgery [(23.1±3.6) vs (29.1±7.1) ml/min;(25.9±4.7) vs (30.7±7.2),both P<0.05]. Conclusion: Retroperitoneal laparoscopic selective renal artery branch occlusion and neon-sparing surgery for patients with ≥ T1b stage renal carcinoma is a safe and effective surgical method, which can well protect the renal function of patients in the early postoperative stage without increasing intraoperative blood loss and postoperative complications.

[Design and application of three-dimensional printing guide plate for oral and maxillofacial surgery]

Objective: To explore the application of three-dimensional (3D) printing technology in oral and maxillofacial surgery, so as to optimize and standardize its design and application. Methods: From January 2010 to December 2020, 40 cases of mandibular tumor surgery (20 cases of conventional group and 20 cases of guide plate group), 20 cases of temporomandibular joint replacement surgery (10 cases of conventional group and 10 cases of guide plate group), 20 cases of malocclusion surgery (10 cases of conventional group and 10 cases of guide plate group), 20 cases of radioactive particle implantation surgery (10 cases of CT guided group and 10 cases of guide plate group) were analyzed. All patients in the guide plate group were scanned with spiral CT, and the 3D models of the jaw and the donor bone area were reconstruction. According to the purpose of surgical guide, the design and clinical application of osteotomy guide, in place forming guide and puncture positioning guide were analyzed respectively. The design time of guide plate, the performance and printing time of guide material, the sterilization method of guide and its influence on accuracy, and the influence of guide application on operation time and accuracy were analyzed. Results: The design time of orthognathic guide plate was (2.9±1.8) d, and the design time of mandibular transplantation guide plate was (2.8±1.8) d, that of the temporomandibular joint replacement guide plate and the puncture guide plate was (2.2±0.3) and (0.9±0.3) d. The average printing time of the 40 maxilla model was (11.1±1.6) h, and that of the 40 mandible models was (2.6±0.4) h. The average printing time of the 40 sets of osteotomy and positioning guide plate was (2.5±0.8) h, and that of the 10 puncture positioning guide plate (1.1±0.4) h. The operation time of the conventional group was (6.99±1.10) and (6.02±0.55) h. In the CT guided group, the operation time was (1.91±0.55) h and (0.89±0.15). The operation time of mandible tumor operation and radioactive particle implantation in the guide plate group was less than that in the control group (P<0.05), and there was no significant difference in the operation time of orthognathic surgery and joint replacement between the two groups (P>0.05). The displacement distance of the mark points in the TMJ replacement and mandibular tumor operation guide group was less than that in the control group (P<0.05), and the error of the guide plate in orthognathic operation and particle implantation operation was basically less than 1 mm. Conclusions: The application of the surgical guide plate made by 3D printing technology helps to complete the operation more safely, accurately and quickly, But its design, manufacture and disinfection still need to be further standardized and improved.

[A comparative study on the radiographs of spiral CT and cone-beam CT in temporomandibular joint osteoarthrosis]

Objective: To observe and compare the radiographs of spiral CT and cone-beam CT (CBCT) in the imaging of temporomandibular joint osteoarthrosis (TMJOA) and to explore the difference between CBCT and spiral CT in detection accuracy so as to provide references for clinical diagnosis and treatment. Methods: A total of 52 patients with TMJOA diagnosed in the Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, from January 2018 to December 2019 were selected. There were 10 males and 42 females, with an average age of 38.6 years (21-70 years). All patients underwent spiral CT and CBCT examinations. Two oral radiologists and two oral and maxillofacial surgeons measured and evaluated the joint spaces and condylar bone lesions of each side of temporomandibular joint. According to the presence or absence of osteoarthrosis, the patients were divided into osteoarthrosis group (92 sides) and non osteoarthrosis group (12 sides). The mean size of joint spaces and the detection rate of lesions were compared between the two groups. SPSS 20.0 was used to analyze the data. Results: There was no significant difference between the measurements of joint space size and joint position in the spiral CT group and the CBCT group (P>0.05). The mean size of the anterior space and the ratio of the posterior condyle in the osteoarthrosis side were larger than that in the normal side. The LR index was smaller in the osteoarthrosis side than that in the normal side indicating that the position of the posterior condyle in the osteoarthrosis side was deviated. However, the difference was not statistically significant (P>0.05). Both spiral CT and CBCT showed good consistency in displaying condylar osteopathy. The most common types of condylar osteopathy was surface defect. The detection rates of defects by spiral CT were surface erosion (85.6%, 89/104), articular surface flattening and shortening (82.7%, 86/104), subcortical sclerosis (40.4%, 42/104), osteophyte (40.4%, 42/104) and subcortical cyst (11.5%, 12/104) respectively. The detection rates of defects by CBCT were surface erosion (88.5%, 92/104), articular surface flattening and shortening (86.5%, 90/104), subcortical sclerosis (35.6%, 37/104), osteophyte (41.3%, 43/104) and subcortical cyst (11.5%, 12/104). There was no statistical difference between the two groups (P>0.05), respectively. Conclusions: Both spiral CT and CBCT showed good accuracies in displaying the osteopathy of TMJOA and the sizes of the joint spaces measured by spiral CT and CBCT were basically the same. Both spiral CT and CBCT could be used as a routine diagnostic method for TMJOA.

[Research progress in signal molecules and transcription factors related to the development of temporomandibular joint in embryonic stage]

Temporomandibular joint (TMJ) is a unique synovial joint in mammals. There have been many reports on the structure and function of TMJ during embryonic development.Although studies on TMJ related signal molecules and transcription factors during embryonic development have been carried out since the last century, there are few reports on the molecular genetic regulation of TMJ compared with the abundant molecular regulation information of synovial joint. The studies on signal molecules and transcription factors of TMJ embryonic development were mainly conducted in rodents.There were few studies on the regulatory molecules and their regulatory mechanisms related to the development of TMJ conducted in large mammals and human embryos. This article reviews the research progress of key signal molecules and transcription factors of TMJ in embryonic development on the basis of modern molecular biology technology in order to find more core regulatory molecules and understand their regulation mechanism on TMJ development.

[Survey on tobacco use and associated factors in population in Shandong province, 2016-2017]

Objective: To understand the status of tobacco use and related influencing factors in population in Shandong province. Methods: Stratified multi-stage cluster sampling was used to select respondents from 216 villages (communities) of 36 districts (counties) in Shandong province. Influencing factors on smoking were analyzed by logistic regression model. Results: The adequate sample size was 6 271 participants. After complex weighted, the current smoking prevalence was 23.93%,45.58% in males and 1.18% in females. The Public's smoking rates varied widely among different groups in the population. 45-64 age group had the highest smoking rate (25.07%). Smoking rates were substantially different in education levels, with the highest in junior high school (28.94%). The rate was higher in the rural area (24.98%) than that in the urban areas (23.08%). The average daily smoking rate was 20.23%. The average age of initiating smoking was 21.21 years. The average daily cigarette intake was 16.31 cigarettes. Among all the former and current smokers, the quitting rate was 20.79%. Multiple logistic regression model analysis showed that gender, age, occupation, region, and health knowledge score were correlated with smoking behavior. The current smoking rate of men was much higher than that of women (OR=49.625, 95%CI: 37.832-65.093). The current smoking rate in 45-64 age group was higher than that in the 15-24 age group (OR=1.830, 95%CI: 1.048-3.194). The current smoking rate of medical (OR=0.403, 95%CI: 0.187-0.866) and retired personnel (OR=0.648, 95%CI: 0.481-0.873) were lower than those engaging in agriculture, forestry, animal husbandry and the fishery ,respectively. The prevalence of residents living in the central part showed lower rate on current smoking than that in the eastern region (OR=0.724, 95%CI: 0.606-0.865). The current smoking prevalence of smoke hazard in 1-3 score group was higher than that in the group with 4-6 score (OR=1.432, 95%CI: 1.240-1.654). Conclusions: Smoking rate in adults in Shandong remained stable and at a high level. Comprehensive intervention measures such as tobacco control and health education should be carried out to reduce the smoking rate.

[Research progress in relationship between vitamin D and myopia and its mechanisms]

Myopia has become an important global public health problem, especially in East Asia. Due to its high prevalence and multiple ocular complications, it is imperative to take effective measures against the development of myopia. Recent studies have shown that outdoor activity is one of the protective factors for myopia and sunlight can delay the progression of myopia. As a possible mediator between sunlight and myopia, vitamin D gradually comes into public view. Vitamin D refers to a kind of secosteroids responsible for regulating calcium and phosphate metabolism. In addition to this main function, it is also correlated with many eye diseases like diabetic retinopathy, age-related macular degeneration, glaucoma etc. This review summarizes relevant epidemiologic and genetic studies as well as possible biological mechanisms to provide theoretical reference for the plausible application of vitamin D in the prevention and therapy of myopia. (Chin J Ophthalmol, 2021, 57: 470-476).

Sirolimus Can Increase the Disappearance Rate of Cardiac Rhabdomyomas Associated with Tuberous Sclerosis: A Prospective Cohort and Self-Controlled Case Series Study

OBJECTIVES

To investigate the efficacy and safety of sirolimus in the treatment of cardiac rhabdomyomas associated with tuberous sclerosis complex and the specific benefits in different subgroups.

STUDY DESIGN

The study was a prospective cohort and self-controlled case series study. Based on the prevalence of cardiac rhabdomyoma at different ages, we estimated the natural tumor disappearance rate. The subgroup analysis was done by Cox regression. Self-controlled case series method was used to assess the magnitude and duration of the drug effect. Adverse events were described.

RESULTS

A total of 217 patients were included in the cohort study. Tumor disappearance rate was higher in younger age groups (hazard ratio = 0.99, P = .027) and female patients (hazard ratio = 2.08, P = .015). The age-adjusted incidence ratio showed that the disappearance of rhabdomyomas between 3 and 6 months was more related to sirolimus. Adverse events were observed 60 times in 42 of 217 children, mainly stomatitis.

CONCLUSIONS

Sirolimus can increase the disappearance rate of cardiac rhabdomyoma in the tuberous sclerosis complex population. Efficacy varies by sex and age: female and younger patients have higher tumor disappearance rate. Sirolimus is well-tolerated.