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Objective Do-not-attempt-resuscitation (DNAR) orders are designed to allow patients to opt out of receiving cardiopulmonary resuscitation in the event of a cardiac arrest. While DNAR has become a standard component of medical care, there is limited research available specifically focusing on DNAR orders in the context of emergency departments in China. This study aimed to fill that gap by examining the factors related to DNAR orders among patients in the emergency department of a general tertiary teaching hospital in China.Design Retrospective observational study.Setting Emergency department.Participants This study and analysis on adult patients with DNAR or no DNAR data between 1 January 2022 and 1 January 2023 in the emergency department of a large academic comprehensive tertiary teaching hospital. A total of 689 were included in our study.Primary outcome measures Whether the patient received DNAR was our dependent variable.Results Among the total patients, 365 individuals (53.0%) had DNAR orders. The following variables, including age, sex, age-adjusted Charlson comorbidity index (ACCI), primary diagnosis of cardiogenic or cancer related, history of neurological dysfunction or cancer, were independently associated with the difference between the DNAR group and the no DNAR group. Furthermore, there were significant statistical differences observed in the choice of DNAR among patients with different stages of cancer.Conclusions In comparison to the no DNAR group, patients with DNAR were characterised by being older, having a higher proportion of female patients, higher ACCI scores, a lower number of patients with a primary diagnosis of cardiogenic and a higher number of patients with a primary diagnosis of cancer related, history of neurological dysfunction or cancer.

AIM: To investigate the effect of latanoprost eye drops on the conjunctival lymphatics. METHODS: Twenty-four healthy New Zealand White rabbits weighing 1.5 to 2.0 kg were randomly divided into three groups: latanoprost group (n=8) administered with latanoprost eye drops once a day for 2mo, carteolol group (n=8) administered with carteolol eye drops once a day for 2mo, and control group (n=8) without any treatment. The conjunctival tissues in the three groups were extracted to investigate the expression levels of 5'-nucleotidase (5'-Nase) by Western blot, reverse transcription-polymerase chain reaction (RT-PCR), and immunofluorescence staining, respectively. RESULTS: The protein expression level of 5'-Nase was significantly higher in latanoprost group than carteolol group (F=231.175, P0.05). The mRNA expression level of 5'-Nase in the latanoprost group was also significantly higher than carteolol group (F=71.169 P

The allo-tetraploid common carp encodes two duplicated fads2 genes (fads2a and fads2b) and two duplicated elovl5 genes (elovl5a and elovl5b). The coding SNPs (cSNPs) of these genes were reported to be significantly associated with the PUFA contents. Whether the promoter SNPs (pSNPs) were associated with the PUFA contents has not been reported yet. In this study, after sequencing the promoters of these four genes, we identified six pSNPs associated with the contents of PUFAs in common carp, including one elovl5a pSNP, one elovl5b pSNP, and four fads2b pSNPs. The pSNPs were predicted in the locations of transcriptional factor binding sites. Together with previously identified cSNPs in fads2b and elovl5b, the pSNPs and cSNPs of these two genes had the joint effects on the PUFA contents with higher explained percentage of phenotypic variation of the PUFA contents than single gene. The expression levels of both fads2a and fads2b were significantly positively correlated with the contents of six PUFAs. The fads2b pSNPs corresponding to higher fads2b expression levels were associated with higher PUFA contents. The pSNPs and cSNPs will be useful for the future selection breeding of common carp with higher PUFA contents.

Abstract Background This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). Methods Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years). Results The mean Harris Hip Score (HHS) significantly (p

Abstract Local tumor failure remains a major problem after radiation‐based nonsurgical treatment for unresectable locally advanced nonsmall cell lung cancer (NSCLC）and inoperable stage II NSCLC. The aim of this study was to evaluate the feasibility of simultaneous integrated boost of intensity‐modulated radiation therapy (SIB‐IMRT) to stage II‐III NSCLC with metastatic lymph nodes (ChiCTR 2000029304). Patients were diagnosed by pathology or PET‐CT. PTV was divided into two parts as follows, the PTV of primary tumor (PTVp) and the PTV of metastatic lymph nodes (PTVn). The radiotherapy doses were simultaneously prescripted 78 Gy (BED = 101.48 Gy) for PTVp and 60‐65 Gy (BED = 73.6‐81.25 Gy) for PTVn, 26f/5.2 weeks. Response was scored according to WHO criteria. Radiotherapy toxicity was scored according to RTOG criteria. Hematology and gastrointestinal toxicity were scored according to CTCAE1.0 criteria. A total of 20 patients were enrolled. Seventeen patients were diagnosed by pathology and three patients were diagnosed by PET‐CT. All patients were treated with SIB‐IMRT. The objective response rate (ORR) was 90%, with CR 25%, PR 65%, NC 10%, and PD 0%. Although radiotherapy toxicity was common, there were no grade ≥3, with radiation pneumonitis (10 cases), esophagitis (17 cases), and dermatitis (12 cases). The local control rates at 1, 3, and 5 years were 85%, 75%, and 70%, respectively. The overall survival（OS）and local progression‐free survival (LPFS) rates at 1, 3, and 5 years were 90%, 42.6%, and 35.5% and 84.4%, 35.5%, and 28.4%, respectively. SIB‐IMRT can significantly improve ORR and survival for stage II‐III NSCLC with metastatic lymph nodes, with high safety, and satisfactory efficacy. However, due to the limitation of small sample, these findings are needed to confirm by future trials with a larger sample size.

Abstract Introduction Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI. Patients and methods This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups. Results Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group. Conclusions Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.

PurposeThe role of radiotherapy, in addition to chemotherapy, has not been thoroughly determined in metastatic non-small cell lung cancer (NSCLC). The purpose of the study was to investigate the prognostic factors and to establish a model for the prediction of overall survival (OS) in metastatic NSCLC patients who received chemotherapy combined with the radiation therapy to the primary tumor.MethodsThe study retrospectively reviewed 243 patients with metastatic NSCLC in two prospective studies. A prognostic model was established based on the results of the Cox regression analysis.ResultsMultivariate analysis showed that being male, Karnofsky Performance Status score < 80, the number of chemotherapy cycles

The allo-tetraploid common carp, one widely cultured food fish, is able to produce poly-unsaturated fatty acids (PUFAs). The genetic markers on the PUFA contents for breeding was limited. The polymorphisms in elovl5a and elovl5b, the rate-limiting enzymes in the PUFA biosynthesis, have not been investigated yet. Herein, we identified one coding SNP (cSNP) in elovl5a associated with the content of one PUFA and two cSNPs in elovl5b with the contents of eight PUFAs. The heterozygous genotypes in these three loci were associated with higher contents than the homozygotes. Together with previously identified two associated cSNPs in fads2b, we found the joint effect of these four cSNPs in fads2b and elovl5b on the PUFA contents with the increased explained percentages of PUFA contents. The genotype combinations of more heterozygotes were associated with higher PUFA contents than the other combinations. Using ten genomic selection programs with all cSNPs in fads2b and elovl5b, we obtained the high and positive correlations between the phenotypes and the estimated breeding values of eight PUFAs. These results suggested that elovl5b might be the major gene corresponding to common carp PUFA contents compared with elovl5a. The cSNP combinations in fads2b and elovl5b and the optimal genomic selection program will be used in the future selection breeding to improve the PUFA contents of common carp.

The allotetraploid common carp is one of the most important freshwater food fish. However, the IBs found in allotetraploid common carp increase the difficulty in fish meat processing and consumption. Although candidate genes associated with the total IB number have been identified, the SNPs associated with the numbers of the total IBs and different forms of IBs have not yet been identified, hindering the breeding of IB-reduced common carp. Herein, the numbers of different types of IBs in three common carp strains were measured. Using whole-genome resequencing and bulked segregant analysis in three pairs of IB-more and IB-less groups, we identified the consensus nonsynonymous SNPs in three strains of common carp. Screening the flanking regions of these SNPs led to the detection of other SNPs. Association study detected 21 SNPs significantly associated with the number of total IBs, epineural-IBs, and ten detailed types of IBs. We observed the joint effects of multiple SNPs on each associated IB number with an improved explained percentage of phenotypic variation. The resulting dataset provides a resource to understand the molecular mechanisms of IB development in different common carp strains. These SNPs are potential markers for future selection to generate IB-reduced common carp.

AIM: To measure the tear film thickness when with a good fitted night wear orthokeratology lens in youth, and observe the change of corneal parameters. METHODS: From July 2015 to August 2016, 51 eyes of 26 teenagers with myopia who would wear orthokeratology and accept regular follow-up were enrolled. The mean spherical equivalent refraction of teenagers was -2.78D±1.53D(-1.00D to-6.00D)before wearing orthokeratology, and the mean astigmatism was 1.29D±0.61D(0 to -2.68D). The tear film thickness were measured by optical coherence tomography(OCT)when the eyes wearing orthokeratology for 1mo. The surface regularity index(SRI)value was measured by corneal topography to compare its relationship with the tear film thickness and the changes of corneal anterior surface parameters during the period of wearing lens were observed. RESULTS: At 1mo after wearing orthokeratology, the mean tear film thickness of right eyes was 230.09±10.40μm, and that was 224.38±10.57μm of left eyes. The mean tear film thickness was 228.75±9.66μm in male eyes and that was 224.80±6.74μm in female eyes. The mean tear film thickness of all eyes was 227.05±10.29μm, and the mean SRI value was 0.16±0.14. There was no correlation between tear film thickness and SRI value(P>0.05). The FK value, SK value and average K value from before wearing to after wearing for 2d and 1wk gradually decreased, the difference was statistically significant(PP>0.05). CONCLUSION: OCT can be used as a safe and reliable method for measuring the thickness of the tear film space during the wearing of orthokeratology, which may be of certain value for the safety assessment of the long term wearing of orthokeratology. Orthokeratology works very quickly, corneal curvature decreases rapidly 2d after wearing and stabilizes during the period.

AIM: To investigate the effect of long-term use of topically administered latanoprost on conjunctival thickness (CT) and conjunctival epithelium thickness (CET) in the patients with glaucoma. METHODS: A series of 106 glaucomatous patients were included. Of the 106 eyes, 55 eyes were treated with latanoprost eye drops once a day (latanoprost group), while 51 eyes were treated with carteolol hydrochloride eye drops (carteolol group). All the included patients completed a 2-year follow-up. CT and CET were measured with optical coherence tomography (OCT) in all patients at presentation and at 2-year visit, respectively. Statistical analysis was then performed to compare the change in CT and CET. RESULTS: At presentation, there was no difference in CET (t=0.400, P=0.689) or CT (t=1.14, P=0.259) between the two groups. No significant difference was found in CET (61.65±5.35 μm at baseline, 60.36±6.36 μm at 2-year follow-up, respectively; t=1.977, P=0.0531), while there was a significant decrease in CT from 201.45±14.99 μm at baseline to 167.81±14.57 μm at 2-year visit (t=14.1407, P

AIM: To explore a feasible method on the establishment of an animal model of conjunctivochalasis (CCH). METHODS: Twelve clean-grade New Zealand white rabbits were divided into four groups (n=3/group): the control group (one received no interventions, and the others underwent subconjunctival injection of sterile water), the matrix metalloproteinases (MMPs) group (administered subconjunctival injection of MMP-3), the aging group (administered subcutaneous injection of D-galactose), the tumor necrosis factor-α (TNF-α) solution group (administered eye drops of TNF-α). Anterior segment photography, conjunctival tissue light microscopy and transmission electron microscopy (TEM) were performed after 12wk. RESULTS: Among all groups, the MMPs group had the following changes: the looser connection between the inferior bulbar conjunctiva and sclera; the more disordered collagen fibers (Trichrome staining) and the broken elastic fibers (Aldehyde-fuchsin staining); the focal necrosis of fibroblasts (TEM). CONCLUSION: Administration of MMPs may be a feasible method for the establishment of an animal model of CCH.

AIM:To compare the similarities and differences of central corneal thickness(CCT)measured by different devices, so as to provide a safe, effective, simple and accurate method for measuring corneal thickness. METHODS: Totally 95 eyes of 95 cataract patients enrolled continuously for preoperative examination in ophthalmology department of Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2016 to December 2016. Handheld automatic PachPen ultrasonic pachymetry(USP), anterior segment optical coherence tomography(AS-OCT)and specular microscopy were respectively used to measure the central corneal thickness, and intraocular pressure was measured at the same time. The similarities and differences of these three different devices to measure the central corneal thickness and their correlations with intraocular pressure were observed. Then the data were analyzed statistically. RESULTS: The CCT value measured by PachPen ultrasonic pachymetry was 544.43±36.61μm, the CCT value measured by AS-OCT was 527.09±35.54μm, and the CCT value measured by specular microscopy was 533.20±30.17μm. There was significant difference between these three groups(F=6.272, P=0.002), and the CCT value measured by PachPen ultrasonic pachymetry was significantly higher than the other two groups. The correlation coefficients between the CCT values of these three groups and intraocular pressure were 0.290, 0.277 and 0.204(PPCONCLUSION: The CCT value measured by PachPen ultrasonic pachymetry is the highest. The second CCT value is measured by specular microscopy, and the smallest CCT value is measured by AS-OCT. Obvious correlation and good consistency were found in the CCT values measured by three types of devices, and the CCT values were all correlated with intraocular pressure. Therefore, we should take more attention in clinic.

Dry eye is a common ocular surface disease, which seriously affects the work and quality of life of the patients. In recent years, physical therapies for dry eye have developed rapidly. This paper summarizes the traditional physical therapies such as fumigation, atomization, eye massage, hot compress, moisture chamber glasses and so on, and bandage contact lenses and scleral contact lenses, intense pulsed light treatment, Blephasteam wet chamber warming device, LipiFlow heat pulse therapy and other advanced physical treatment methods widely used in recent years. We review the recent research progress about physical therapies for dry eye to provide reference for clinical treatment.

Fatty acid desaturase 2 (fads2) is one of the rate-limiting enzymes in PUFAs biosynthesis. Compared with the diploid fish encoding one fads2, the allo-tetraploid common carp, one most important food fish, encodes two fads2 genes (fads2a and fads2b). The associations between the contents of different PUFAs and the polymorphisms of fads2a and fads2b have not been studied. The contents of 12 PUFAs in common carp individuals were measured, and the polymorphisms in the coding sequences of fads2a and fads2b were screened. We identified five coding single nucleotide polymorphisms (cSNPs) in fads2a and eleven cSNPs in fads2b. Using the mixed linear model and analysis of variance, a synonymous fads2a cSNP was significantly associated with the content of C20:3n-6. One non-synonymous fads2b cSNP (fads2b.751) and one synonymous fads2b cSNP (fads2b.1197) were associated with the contents of seven PUFAs and the contents of six PUFAs, respectively. The heterozygous genotypes in both loci were associated with higher contents than the homozygous genotypes. The fads2b.751 genotype explained more phenotype variation than the fads2b.1197 genotype. These two SNPs were distributed in one haplotype block and associated with the contents of five common PUFAs. These results suggested that fads2b might be the major gene responding to common carp PUFA contents and that fads.751 might be the main effect SNP. These cSNPs would be potential markers for future selection to improve the PUFA contents in common carp.

The PubMed, MEDLINE databases and China National Knowledge Infrastructure (CNKI) were searched for information regarding the etiology and pathogenesis of conjunctivochalasis (CCh) and the synthesis and degradation of elastic fibers. After analysis of the literature, we found elastic fibers was a complex protein molecule from the structure and composition; the degradation of elastic fibers was one of the histopathological features of the disease; the vast majority of the factors related to the pathogenesis of CCh ultimately pointed to abnormal elastic fibers. By reasonably speculating, we considered that abnormal elastic fibers cause the conjunctival relaxation. In conclusion, we hypothesize that elastic fibers play an important role in the pathogenesis of CCh. Studies on the mechanism of synthesis, degradation of elastic fibers are helpful to clarify the pathogenesis of the disease and to find effective treatment methods.

AIM: To investigate the expression of matrix metalloproteinases 1 and 3 (MMP-1 and MMP-3) and their tissue inhibitors of metalloproteinases 1 and 3 (TIMP-1 and TIMP-3) in the conjunctiva of eyes with conjunctivochalasis (CCh). METHODS: The conjunctival tissue was obtained from the CCh patients and controls, the MMPs/TIMPs expression concentration was determined by enzyme-linked immuno-sorbent assay (ELISA) and immunofluorescence staining. The expression levels of MMPs/TIMPs in the CCh fibro-blasts were determined by analyzing its concentration in the cellular supernatant that was abstracted from the in vitro cultured CCh fibroblasts. RESULTS: MMP-1 and MMP-3 levels determined by ELISA were both significantly higher in the CCh group than that in the control group (P=0.042, 0.022, respectively), so was the levels of TIMP-1 (P=0.010). No significant difference in the expression of TIMP-3 in conjunctiva was found between the two groups (P=0.298). The expression of MMP-1 and MMP-3 were both up-regulated significantly in the CCh group (P=0.040, 0.001, respectively) on immuno-fluorescence staining. MMP-1 and MMP-3 expression in the fibroblasts were both significantly higher in the CCh group than that in the control group (P=0.027, 0.001, respectively), while neither the TIMP-1 nor TIMP-3 expression was significantly different between the two groups (P=0.421, 0.237, respectively). CONCLUSION: The overexpression of MMP-1 and MMP-3 in conjunctival tissue and fibroblasts may play an important role in the pathogenesis and development of CCh.

AIM:To observe thickness and morphological changes of cornea and bulbar conjunctiva pre- and post acute angle closure glaucoma(AACG)therapy by optical coherence tomography(OCT). METHODS:Twenty-five patients with AACG were recruited. Intraocular pressure(IOP)and morphological characteristic of cornea and conjunctiva were measured at their first visit, 1, 2 and 3d after they began the treatments. RESULTS:The corneal epithelium thickness and corneal thickness of patients with acute attack of angle closure glaucoma were 72.76±11.95μm and 589.40±66.91μm; the conjunctival epithelial layer thickness was 58.88±12.87μm; the thickness of conjunctive stroma was 299.76±94.86μm; the conjunctival full thickness was 358.64±102.55μm. The corneal epithelium thickness and corneal thickness at the first day of the treatment were 69.28±12.65μm and 579.04±67.88μm; the conjunctival epithelial layer thickness was 57.04±12.05μm; the thickness of conjunctive stroma was 282.44±91.47μm; the conjunctival full thickness was 339.48±100.28μm. the corneal epithelium thickness and corneal thickness at the second day of treatment were 66.76±11.42μm and 563.32±63.87μm; the conjunctival epithelial layer thickness was 54.76±11.01μm; the thickness of conjunctive stroma was 267.00±98.54μm; the conjunctival full thickness was 322.16±106.12μm. the corneal epithelium thickness and corneal thickness of the third day treatment are 65.16±12.25μm and 550.36±71.48μm; the conjunctival epithelial layer thickness was measured 53.36±10.29μm; the thickness of conjunctive stroma was 252.76±99.32μm; the conjunctival full thickness was 306.52±107.31μm. The difference of IOP, corneal epithelial thickness, corneal thickness, conjunctival epithelial layer thickness, conjunctival stroma thickness and conjunvtival full thickness had statistically significant(PCONCLUSION:The corneal and conjunctival thickness in patients at acute attack of angle closure glaucom increase. The edema level decreases with IOP.

Collagen protein has special biological characteristics and physical properties, including quaternary structure, low immunogenicity, biocompatibility, biodegradability and hemostatic properties and so on, which are the foundation of collagen protein being widely used and it has important relationship with the occurrence and development of some eye diseases, such as keratoconus, conjunctivochalasis, high myopia, etc. This paper reviews the recent progress of collagen protein in eye diseases.

Glaucoma is the second blindness disease in the world, and there are more primary angle closed glaucoma in China. The anatomy changes of the anterior chamber have close relationships with the development of glaucoma. Anterior segment optical coherence tomography(AS-OCT)has the advantages of fast, non-contact, high resolution and accurate quantitative measurement, which provides a kind of important method for finding the pathogenesis of primary angle closed glaucoma, for early diagnosis and treatment of glaucoma, and for the postoperative evaluation of glaucoma.

AIM: To observe thickness and morphological changes of bulbar conjunctiva pre- and post epidemic hemorrhagic conjunctivitis(EHC)therapy by optical coherence tomography(OCT).METHODS: Observed morphological changes and measured the bulbar conjunctiva thicknesses of 29 cases(36 eyes)of incipient(1-2d)EHC patients, who were received and treated by department of ophthalmology, the Putuo Affiliated Hospital of Shanghai University of Traditional Chinese Medicine from May 2013 to December 2013, by OCT. Then measured the thickness again on 7, 14d after the therapy. RESULTS: Among 29 patients(36 eyes), 7d after the EHC therapy, in 27 cured eyes, the full-thickness(before 344.00±59.91μm, after 230.19±22.16μm, t=11.75, Pt=4.61, Pt=10.69, Pt=14.45, Pt=10.06, Pt=13.11, PCONCLUSION: The OCT is able to measure the thickness of bulbar conjunctiva in EHC patients. An significant increase was found in full, epithelial and stromal thickness of EHC patients' bulbar conjunctiva. With recovery from the disease, subepithelial fluid, interlaminar fluid and edema of the bulbar conjunctival stroma faded away firstly, which provide references for clinical therapies of the EHC.