[Delineation of water ecological restoration zoning from a multi-dimensional perspective: A case study in Hechi, a typical karst region]. / 多维视角下水生态修复分区划定­­ä»¥å ¸åž‹å–€æ–¯ç‰¹åœ°åŒºæ²³æ± 市为例.

Water ecological restoration zoning, which involves articulating goals for restoring water ecosystems upwards and guiding the spatial layout of restoration projects downwards, is key to achieving systematic restoration of water resource elements. There are many challenges in water ecological restoration zoning, including disparate hierarchical systems, incomplete indicators, and vague boundaries. With Guangxi Hechi, a karst ecologically fragile region, as a case, we developed a multidimensional zoning system framework based on "watershed natural unit-dominant ecological function-ecological stress risk". The first-level zoning employed river systems and geomorphic types as indicators and delineated the sub-watershed unit as the boundary. The second-level zoning adopted a "top-down" division method to clarify the goal of water ecological restoration based on watershed natural geography and select three indicators (water conservation, biodiversity, and landscape cultural services) for evaluation. We used the K-means clustering method to identify dominant ecological functions in spatial units, with the sub-watershed unit demarcating second-level zoning boundaries. The third-level zoning was the specific implementation unit for ecological restoration projects. We used three indicators (soil erosion, flooding risk, and human interference) to characterize water ecosystem risk from external coercion, and defined the third-level zoning. We delineated 11 primary water ecological zones, four secondary zones, and three tertiary zones. Synthesizing tertiary zoning results accounted for spatial differentiation characteristics of watershed natural geography, dominant ecological functions, and ecological coercion risks, and combining sub-watershed and township administrative units determined zoning boundaries, water ecological restoration zoning was comprehensively classified into five categories and 32 sub-ecological zones. Corresponding ecological restoration strategies were proposed based on zoning and classification.

Two-year outcomes of anterior versus posterior scleral application of mitomycin C-soaked sponge in trabeculectomy.

PURPOSE: To compare the safety and efficacy of two different application methods of mitomycin C (MMC)-soaked sponge in trabeculectomy. STUDY DESIGN: Retrospective study. METHODS: We included 71 eyes of 71 patients that had undergone trabeculectomy. In the anterior scleral application group, 36 eyes were treated using the long side of the MMC-soaked sponge placed parallel to the limbus. The efficacy and safety in these eyes were compared with eyes treated with the posterior scleral application group, consisting of 35 eyes treated with the long side of the MMC-soaked sponge placed perpendicular to the limbus. The follow-up period was 2 years. The safety of the procedure, including bleb morphology and complications, was the primary outcome, while the success rate was the secondary outcome. RESULTS: The cumulative success rate at 2 years postoperatively was 94.4% in the anterior and and 94.3% in the posterior scleral application group (P = 1.000). However, with the posterior scleral application of the MMC-soaked sponge, blebs were more low-lying (P = 0.048), less in extent (P < 0.001), more normally vascularized (P = 0.027) and more posteriorly directed (P < 0.001). Furthermore, the incidence of thin-walled cystic bleb (P = 0.028) and bleb leakage (P = 0.025) was significantly lower in the posterior scleral application group than in the anterior group. CONCLUSION: Although there were similar success rates, the posterior scleral application of MMC-soaked sponge with trabeculectomy was safer with a better bleb morphology than the anterior scleral application.

Factors influencing willingness to participate in ophthalmic clinical trials and strategies for effective recruitment.

AIM: To explore the factors influencing individuals' willingness to participate in ophthalmic clinical trials. METHODS: A questionnaire survey was conducted from January to April 2021 among patients and their family members at Zhongshan Ophthalmic Center, Sun Yat-sen University, in Guangzhou, China. The survey gathered data on respondents' willingness, demographic and socioeconomic profiles, as well as their reasons and concerns regarding engagement in clinical trials. RESULTS: Of the 1078 residents surveyed (mean age 31.2±13.1y; 65.8% females) in Guangzhou, 749 (69.5%) expressed a willingness to participate in future ophthalmic clinical trials. Specific characteristics associated with greater willingness included a younger age, lower annual income, higher education, prior participation experience, previous ophthalmic treatment, and a better understanding of clinical trials. With the exception of age, these characteristics were significantly linked to a higher willingness. The primary barrier to participation, expressed by 64.8% of those willing and 54.4% of those unwilling, was "Uncertain efficacy". In terms of motivations, the willing group ranked "Better therapeutic benefits" (35.0%), "Professional monitoring" (34.3%), and "Trust in healthcare professionals" (33.1%) as their top three reasons, whereas the unwilling participants indicated "Full comprehension of the protocol" (46.2%) as the key facilitator. CONCLUSION: This study reveals a substantial willingness to participate in ophthalmic clinical trials and demonstrates the predictive role of demographic and socioeconomic factors. Variations in motivators and concerns between willing and unwilling participants highlight the significance of tailored recruitment strategies. Importantly, the need for and trust in healthcare professionals stand out as powerful motivations, underscoring the importance of enhancing physician-patient relationships, adopting patient-centered communication approaches, and addressing individualized needs to improve accrual rates.

Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy.

AIM: To evaluate the safety and efficacy of posterior scleral application (a modified technique) of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma. METHODS: This retrospective study included 101 patients (115 eyes) with glaucoma (aged 12-83y) who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method. A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus. The mitomycin C concentration and exposure time were 0.2-0.5 mg/mL and 1-5min, respectively. Intraocular pressure, best-corrected visual acuity, and hypotensive medications were recorded at baseline and at the final visit. Complications, interventions required, and bleb morphology were recorded postoperatively. The primary outcome was trabeculectomy safety, including complications and bleb morphology; the secondary outcome was the trabeculectomy success rate. RESULTS: At the final follow-up [median 28mo, range 7-67mo and interquartile range (IQR) 13mo], the qualified (cumulative) success rate was 93.0% and the complete success rate was 60.0%. No bleb-related complications were observed. The mean height, extent, and vascularity grades were 0.6±0.9, 1.1±0.4, and 2.4±0.9, respectively. All Seidel tests were negative. The mean posteriority grade was 0.8±0.4. CONCLUSION: Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

The Adverse Impact of Glaucoma on Psychological Function and Daily Physical Activity.

PURPOSE: To evaluate the impact of glaucoma on vision-related quality of life and physical activity. METHODS: This study included 50 glaucoma patients and 50 healthy control subjects. Sociodemographic and clinical data were collected from all subjects. A Chinese version of the NEI VFQ-25 was used to evaluate the quality of life. Objective physical activity was assessed by wearing an accelerometer for 7 consecutive days. RESULTS: No significant difference was found in sociodemographic data between the two groups (all p < 0.05). Visual acuity and visual field scores were worse in the glaucoma group than in the control group (all p < 0.001). The VFQ-25 scores indicated significantly lower scores for ocular pain, social function, mental health, role difficulties, and color vision in the glaucoma group than in the normal group (all p < 0.05). The average daily step count was lower in the glaucoma group than in the normal group. High, moderate, and low average daily step counts in the glaucoma group were associated with early-, moderate-, and advanced-stage glaucoma, respectively, while the step count was significantly lower in the advanced-stage glaucoma group than in the control group (p=0.037). A positive relationship was found between the average daily step count and social function and mental health (both p < 0.05). CONCLUSIONS: We demonstrated an adverse impact of glaucoma on psychological function and daily physical activity. Social function and mental health showed declines in glaucoma patients, and physical activity was limited in patients with advanced-stage glaucoma.