A clearer vision: unveiling the importance of cycloplegic refraction and the pseudomyopia prevalence in Chinese preschoolers.

BACKGROUND: This study aimed to investigate the difference between cycloplegic and noncycloplegic refraction and evaluate the pseudomyopia prevalence in Chinese preschool children during the outbreak of COVID-19. METHODS: A cross-sectional study was conducted in the Tongzhou District of Beijing, China. Refractive error was measured under both noncycloplegic and cycloplegic conditions with autorefraction. The difference between noncycloplegic and cycloplegic spherical equivalent refraction (SER) and pseudomyopia prevalence were analyzed. Pseudomyopia was defined as SER ≤-0.50D in precycloplegic assessments and >-0.50D in post-cycloplegic assessments. RESULTS: Out of the 1487 participants who were enrolled in the study, 1471 individuals (98.92%) between the ages of 3-6 years completed all required procedures. A statistically significant difference in refraction was observed between noncycloplegic and cycloplegic measurements, the median of difference in spherical equivalent refraction (SER) of 0.88D (dioptre)(0.50,1.38). There was a high intraclass correlation (ICC) between these two methods for cylinders (ICC = 0.864; 95% CI, 0.850-0.877). The median DSE for myopia, emmetropia and hyperopia were 0.25D (0.00, 0.38),0.25D (0.06, 0.50) and 1.00D (0.62, 1.38), an hypermetropes showed considerably greater differences than myopes and emmetropes (Kruskal-Wallis test, H = 231.023, P = 0.000). Additionally, girls displayed a greater DSE than boys. Furthermore, when comparing against-the-rule (ATR) and oblique astigmatism, it was found that with-the-rule (WTR) astigmatism had the largest DSE. The study found varying prevalence rates of myopia, emmetropia, and hyperopia with and without cycloplegia, which were 1.90% vs. 10.06%, 11.49% vs. 50.31%, and 86.61% vs. 39.63%, respectively. Additionally, the overall prevalence of pseudomyopia was determined to be 8.29%. Participants with pseudomyopia had a significantly higher mean difference in SER (DSE) compared to non-pseudomyopic participants. CONCLUSIONS: Cycloplegic refraction is more sensitive than a noncycloplegic one for measuring refractive error in preschool children. Pseudomyopia is prevalent in preschool children during the COVID-19 outbreak period. Our study indicates the possibility that cycloplegic refraction should be performed in preschool children routinely.

Combined use of CDAI and blood indices for assessing endoscopic activity in ileocolic Crohn's disease.

BACKGROUND: Mucosal healing has become the primary treatment target for patients with Crohn's disease (CD). We aimed to develop a noninvasive and convenient tool to evaluate the endoscopic activity in patients with ileocolic CD. METHODS: A retrospective multicenter study including 300 CD patients (training, 210 patients; test, 90 patients) was conducted at two tertiary referral centers. Independent risk factors associated with endoscopic activity were explored, which were then combined into a comprehensive index. The predictive performance was evaluated with the area under receiver operating characteristic curve (ROC). Cohen's Kappa was adopted to examine the consistency between each indicator and endoscopic activity. RESULTS: A total of 210 CD patients were recruited in the training cohort. We found that Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP) and platelet-to-lymphocyte percentage ratio (PLpR) were independently associated with endoscopic activity. Additionally, the comprehensive index generated from the above three indices achieved good discrimination and performed better than CDAI in AUC (0.849 vs. 0.769, P < 0.05). This was further well demonstrated by the external test cohort, which showed good discrimination (AUC: 0.84, 95% CI: 0.744-0.936). Intra-individual comparison revealed the comprehensive index to be superior in the prediction of endoscopic activity. In the subgroup analysis, the AUC of comprehensive index was significantly higher than CDAI especially in inflammatory phenotype (0.824 vs. 0.751, P < 0.05). CONCLUSION: Combining CDAI, CRP and PLpR significantly improved the accuracy for predicting endoscopic activity in ileocolic CD, which can help better monitor an endoscopic flare.

Refraction and ocular biometric parameters of preschool children in the Beijing whole childhood eye study: the first-year report.

BACKGROUND: Prevention of myopia should begin before school age. However, few population-based cohort studies have investigated refractive status in preschool children with cycloplegia. This study aimed to investigate the post-COVID-19 refraction and ocular biometric parameters of preschool children in Beijing Tongzhou District. METHODS: A population-based cohort study of kindergarten children in Tongzhou District, Beijing, commenced in November 2021. The present study reports data from the first year of the aforementioned population-based study. We selected children aged 3-6 years from nine kindergartens. Biometric parameters, including axial length (AL), anterior chamber depth (ACD), and corneal radius of curvature (CR), were collected before cycloplegia. Cycloplegic refraction was also measured. The spherical equivalent (SE), lens power (LP), and AL-to-CR ratio were calculated. Multiple linear regression analysis was used to analyse the correlation between refraction and ocular biometric parameters. RESULTS: A total of 1,505 children completed the examination, and a mean SE of 1.24 ± 0.91 D was found. The overall prevalence of myopia was 1.93%. The mean AL, ACD, CR, LP, and AL-to-CR ratio were 22.24 ± 0.70 mm, 3.28 ± 0.26 mm, 7.77 ± 0.26 mm, 26.01 ± 1.56 D, and 2.86 ± 0.07, respectively. Longer AL, deeper ACD, larger AL-to-CR ratio, and lower LP were associated with older age; the CR was not significantly different among different ages. In the multiple linear regression analysis, after adjusting for sex and age, the model that included AL, CR, and LP explained 87% of the SE variation. No differences were observed in the prevalence of myopia or the SE in this particular age range. CONCLUSION: The findings of this study suggest that a large proportion of preschool children in Beijing are mildly hyperopic, with a considerably low prevalence of myopia. In preschool children, refractive development was found to present mild hyperopia rather than emmetropia or myopia, a phenomenon that is characteristic of this age range.

Effect of Atropine 0.01% Eye Drops on the Difference in Refraction and Axial Length between Right and Left Eyes.

INTRODUCTION: This study sought to determine whether the application of 0.01% atropine eye drops could impact the disparity in refraction and axial length (AL) between the right and left eyes in Chinese children. METHODS: The study was designed as a double-blind, placebo-controlled randomized trial. A total of 220 children aged 6-12 years were recruited from the Beijing Tongren Hospital in Beijing, China. Participants were randomized in a 1:1 ratio and were prescribed 0.01% atropine or placebo eye drops to be administered once a night to both eyes for the duration of 1 year. The cycloplegic refraction and AL were recorded including baseline, 6 months, and again at the 12 months. RESULTS: After 1-year follow-up period, 76 (69%) and 83 (75%) subjects of the initial 220 participants were identified as the 0.01% atropine and placebo groups, respectively. The inter-ocular difference in spherical equivalent refraction (SER) and AL demonstrated stable values in the 0.01% atropine treatment group (SER: p = 0.590; AL: p = 0.322) analyzed after 1 year, but found a significant increase (SER: p < 0.001; AL: p = 0.001) in the placebo group. Furthermore, over 1 year, eyes with greater myopia in the atropine group exhibited slower myopia progression (0.45 ± 0.44 D) than the lesser myopic eye (0.56 ± 0.44 D) (p = 0.003). CONCLUSION: This study demonstrated that 0.01% atropine could maintain the inter-ocular SER and AL difference. And 0.01% atropine appeared to be more effective in delaying the progression of myopia in eyes with more myopia than in the less myopic eyes.

Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study.

PURPOSE: To explore the distribution of stereoacuity and to examine its determinants in school-age children in Tibetan plateau, Southwest China. METHODS: This is the cross-sectional part of a school-based cohort study of 7-year-old children in Lhasa, Tibet Autonomous Region, Southwest China. Children in first year of primary school were invited to undergo a comprehensive examination, including height, weight, visual acuity, cycloplegic autorefraction (1% cyclopentolate), anterior segment, cover and uncover test, and stereoacuity (Titmus Stereo Test). RESULTS: A total of 1833 eligible subjects were included, with a mean age of 6.82 ± 0.46 years. Mean stereoacuity was 1.78 ± 0.21 in log units (median: 60 arcsec). Children with stereoacuity equal to 40 arcsec and stereoacuity worse than 100 arcsec accounted for 29.24% and 8.18% of the cohort, respectively. Tibetan ethnicity (OR = 1.98; 95%CI, 1.30-3.03), astigmatism (OR = 1.65; 95%CI, 1.26-2.17), strabismus (OR = 2.92; 95%CI, 1.38-6.18), and amblyopia (OR = 3.77; 95%CI, 1.14-12.49) were risk factors for normal stereoacuity (= 40 arcsec). Shorter height, younger age, strabismus, and worse BCVA (P < 0.05 for all) were both related to lower stereoacuity in Spearman correlation analysis and associated with lower stereoacuity in multivariate regression analysis. CONCLUSION: Stereoacuity maturation does not appear fully completed in 7-year-old children, while few children present stereoacuity worse than 100 arcsec (8.18%). Lower stereoacuity was associated with younger age, shorter height, strabismus, and lower best-corrected visual acuity.

Pinhole does not increase screening accuracy of detecting decreased best corrected visual acuity in schoolchildren.

BACKGROUND: Decreased best corrected visual acuity among children should be treated early in life, and vision screening in schoolchildren is an efficient and feasible selection for developing countries. Thus, the screening accuracy of different visual acuity tests is the key point for making vision screening strategies. The present study aims to explore the screening accuracy of uncorrected visual acuity (UCVA) and pin-hole corrected visual acuity (PCVA) using different vision chart in the detection of decreased best-corrected visual acuity (BCVA) among schoolchildren. METHODS: Grade one primary schoolchildren in urban Lhasa with data of UCVA using tumbling E chart (UCVAE), PCVA using tumbling E chart (PCVAE), UCVA using Lea Symbols chart (UCVAL), PCVA using Lea Symbols chart (PCVAL) and BCVA using Lea Symbols chart were reviewed. Decreased BCVA was defined as BCVA≤20/32(≥0.2 logMAR). Difference, reliability, and diagnostic parameters in the detection of decreased BCVA of different visual acuity results were analyzed. RESULTS: Overall, 1672 children aged 6.58 ± 0.44 years fulfilling the criteria. The prevalence of decreased BCVA was 6.8%. Although no significant differences were found between UCVAE vs UCVAL (p = .84, paired t-test) as well as PCVAE vs PCVAL (p = .24), the ICC between them was low (0.68 and 0.57, respectively). The average difference between BCVA and UCVAE, UCVAL, PCVAE, PCVAL was logMAR -0.08 (- 0.37, 0.21), - 0.08 (- 0.29, 0.17), - 0.05 (- 0.30, 0.19), - 0.06 (- 0.23, 0.12) using Bland-Altman method. The area under the receiver operating characteristic curve of UCVAE, PCVAE, UCVAL, PCVAL for the detection of decreased BCVA was 0.78 (0.73, 0.84), 0.76 (0.71, 0.82), 0.95 (0.94, 0.96), 0.93 (0.91, 0.95), respectively. CONCLUSION: Pinhole does not increase the screening accuracy of detecting decreased BCVA in grade one primary schoolchildren. Visual acuity test using Lea Symbols is more efficient than Tumbling E in the screening of that age. TRIAL REGISTRATION: Data were maily from the Lhasa Childhood Eye Study which has finished the clinical registration on ( ChiCTR1900026693 ).

MoS2 quantum dots as a specific fluorescence sensor for selection of rutin and for temperature sensing.

A selective and sensitive method for detecting rutin using MoS2 quantum dots (QDs) as a fluorescent probe is reported in the paper, a one-step hydrothermal synthesis method was used to prepare MoS2 QDs. The synthesized MoS2 QDs had good stability and water solubility, and the fluorescence of MoS2 QDs was quenched by rutin due to the inner filter effect. There was a good linear relationship between the intensity of MoS2 QDs and rutin concentration ranging from 5.0 × 10-7 to 3.2 × 10-5 mol/L with a detection limit of 3.5 × 10-7 mol/L. MoS2 QDs showed temperature-dependent fluorescence that had an excellent linear relationship between 20 and 80°C. Therefore MoS2 QDs can be used as specific fluorescence sensors for selection of rutin and for temperature sensing.

Comparative effects of fentanyl versus sufentanil on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing open surgery.

This study was aimed to systematically evaluate the effects of fentanyl and sufentanil on intraoperative cerebral oxygen saturation changes and postoperative cognitive function in elderly patients undergoing open surgery. Ninety-six elderly patients who had undergone open surgery under general anesthesia were randomly divided into fentanyl group (F group, anesthesia by fentanyl, 4 g/kg) and sufentanil group (S group, anesthesia by sufentanil, 0.4 µg/kg). There were no significant differences between the F group and S group in the general characteristics of patients. Compared to the F group, the S group had a better effect on suppressing the stress response, maintaining a stable hemodynamic status and achieving better anesthesia effects. The anesthesia recovery time of the S group was significantly shorter than that of the F group. There was no significant difference between the two groups in the intraoperative and postoperative agitation. Patient's waking time and extubation time were significantly shorter in the S group than the F group. The VAS scores in the S group were significantly lower than those in the F group at each time point. The Ramsay scores in the S group were significantly higher than those in the F group at each time point. The cerebral oxygen saturation (SctO2) levels in both groups were significantly increased following anesthesia induction and intubation compared to that of the awake state (P < 0.05), and SctO2 was significantly decreased during the surgery in both groups. The changes in SctO2 levels were not significantly different between the two groups (P > 0.05). The SctO2 level was significantly higher during surgery than that after intubation. Compared with the F group, the relative value of SctO2 decline in the S group was smaller. Compared to the day before surgery, the Montreal Cognitive Assessment (MoCA) scores of both groups were significantly reduced after surgery. At 1 day post-surgery, the MoCA scores of the S group were significantly higher and the incidence of postoperative cognitive dysfunction (POCD) was significantly lower compared to the F group. POCD occurred in three patients (6.2%) in the S group, and the ratio was significantly lower than that in the F group (11.9%) (P < 0.05). It showed a consistent trend with the SctO2 status during the surgery. The relative value of SctO2 decline in the S group was significantly smaller than that in the F group. The reduction of cognitive function in the S group was significantly lower than that in the F group. These results indicate that the changes in SctO2 are a good prediction of the incidence of POCD.

An ionic liquid-magnetic graphene composite for magnet dispersive solid-phase extraction of triazine herbicides in surface water followed by high performance liquid chromatography.

A new ionic liquid-magnetic graphene (IL-MG) composite was used as the adsorbent in magnetic dispersive solid-phase extraction to rapidly extract and isolate triazine herbicides from surface water. IL-MG was synthesized by a simple and time-saving one-pot strategy where the synthesis of magnetic Fe3O4, the modification with an IL, and the reduction of graphene oxide to graphene were conducted at the same time. An IL was applied to enrich the interaction mechanism between IL-MG and analytes (π-π, hydrophobic interaction, and electrostatic interaction). Moreover, the IL and Fe3O4 nanoparticles acted as spacers, inserting between the layers of graphene to prevent the aggregation of graphene, which improved the adsorption ability because of the large specific surface area of IL-MG. The resultant IL-MG had hierarchical flake structures and showed a high adsorption capacity (8266.0-12 324.1 µg g-1) toward triazine herbicides. Under suitable conditions, the linearity for triazine herbicides was achieved in the range of 0.55-500 ng mL-1 with a detection limit of 0.09-0.15 ng mL-1 and a quantitation limit of 0.31-0.51 ng mL-1, and the enrichment factor was 83-fold, which indicated that the proposed method could be successfully applied for the determination of triazine herbicides in surface water.

Effect of uncorrection versus full correction on myopia progression in 12-year-old children.

PURPOSE: To investigate the effects of no correction versus full correction on myopia progression in Chinese children over a period of 2 years. METHODS: Myopia was defined as cycloplegic spherical equivalent (SE) of ≤ -0.50 D. Uncorrection was defined as no spectacles worn, and full correction was defined as when the value of SE subtracted from the dioptric power of the child's current spectacles was less than 0.5 D. Ocular examinations included visual acuity, cycloplegic autorefraction, axial length and vertometer measurements. Questionnaires were completed by parents on behalf of the children. RESULTS: A total of 121 myopic children, with a median age of 12.7 years, were screened from the Anyang Childhood Eye Study, with 65 in the uncorrected group and 56 in the full correction group. At 2-year follow-up, children with no correction had slower myopia progression (-0.75 ± 0.49 D vs. -1.04 ± 0.49 D, P < 0.01) and less axial elongation (0.45 ± 0.18 mm vs. 0.53 ± 0.17 mm, P = 0.02) than children with full correction. In multivariate modeling, adjusting for baseline SE or axial length, age, gender, height, number of myopic parents, age at myopia onset, and time spent in near work and outdoors, children with no correction still had slower myopia progression (-0.76 ± 0.07 vs. -1.03 ± 0.08 D, P < 0.01) and less axial elongation (0.47 ± 0.03 mm vs. 0.51 ± 0.03 mm, P < 0.01). Myopia progression decreased significantly with an increasing amount of undercorrection in all children (r = 0.22, b = 0.16, P = 0.01). CONCLUSION: Our findings suggest that myopic defocus slows the progression of myopia in already myopic children, supporting previous findings from animal studies.

Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis.

PURPOSE: To evaluate the effect of soft contact lens with concentric ring bifocal and peripheral add multifocal designs on controlling myopia progression in school-aged children. METHODS: We systematically searched MEDLINE, EMBASE, Cochrane Library and reference lists of included trials. Methodological quality of included trials was assessed using Jadad Scale and Newcastle-Ottawa Quality Assessment Scale items. RESULTS: We identified five randomised controlled trials (RCTs) and three cohort studies with a total of 587 myopic children. Compared with the control group, concentric ring bifocal soft contact lenses showed less myopia progression with a weighted mean difference (WMD) of 0.31 D (95% CI, 0.05~0.57 D, p = 0.02) and less axial elongation with a WMD of -0.12 mm (95% CI, approximately -0.18 to -0.07 mm, p < 0.0001) at 12 months. Relative to the control group, peripheral add multifocal soft contact lenses showed less myopia progression with a WMD of 0.22 D (95% CI 0.14~0.31 D, p < 0.0001) and less axial elongation of -0.10 mm (95% CI -0.13~0.07 mm, p < 0.0001) at 12 months, respectively. The soft contact lenses with concentric ring bifocal and peripheral add multifocal designs produced additional myopia control rates of 30~38% for slowing myopia progression and 31~51% for lessening axial elongation within 24 months. CONCLUSIONS: Both concentric ring bifocal and peripheral add multifocal soft contact lenses are clinically effective for controlling myopia in school-aged children, with an overall myopia control rates of 30~50% over 2 years. Concentric ring bifocal soft contact lenses seem to have greater effect than peripheral add multifocal soft contact lenses.

Tramadol differentially regulates M1 and M2 macrophages from human umbilical cord blood.

Tramadol is an analgesic drug and relieves pain through activating µ-opioid receptors and inhibiting serotonin and noradrenaline reuptake. Emerging evidence shows that it also stimulates immune cells, including NK cells, splenocytes, and lymphocytes, and elevates IL-2 production. However, it remains unknown whether and how tramadol directly affects macrophages. To answer these questions, we collected human umbilical cord blood, isolated macrophages, and examined their responses to tramadol. Although tramadol did not alter resting macrophages and the antigen-presenting function in lipopolysaccharide-activated macrophages, it regulated M1 and M2 macrophages, which are, respectively, transformed by IFN-γ and IL-4. Interestingly, tramadol inhibits production and secretion of cytokines in M1 macrophages, but facilitates the production of inflammation-responding molecules, synthesized in M2 macrophages. We also found that STAT6 cascade pathway in M2 macrophages was significantly enhanced by tramadol. Therefore, this study reveals that tramadol regulates inflammation by inhibiting M1 macrophages (killing process), but promoting the function of M2 macrophages (healing process).

Case report: successful resection of a leiomyoma causing pseudoachalasia at the esophagogastric junction by tunnel endoscopy.

BACKGROUND: Pseudoachalasia is a rare disorder whose presentation strongly resembles idiopathic achalasia. CASE PRESENTATION: Here, we present a case of a 42-year-old female patient with esophageal leiomyoma who was initially diagnosed with achalasia. On endoscopical investigation, however, it became apparent that she had pseudoachalasia as consequence of a leiomyoma at the esophagogastric junction (EGJ). The condition was successfully treated through submucosal tunneling endoscopic resection. CONCLUSION: This case suggests that submucosal tunneling endoscopic resection is a therapeutic u option for the treatment of pseudoachalasia caused by leiomyoma of EGJ.

Peripapillary retinal nerve fibre layer thickness and its association with refractive error in Chinese children: the Anyang Childhood Eye Study.

BACKGROUND: To report the thickness of the peripapillary retinal nerve fibre layer (pRNFL) in Chinese children and examine its association with refractive error, axial length (AL) and optic disc parameters. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 2893 seven-year-old children from 11 randomly selected primary schools in Anyang, central China. METHODS: Participants underwent ophthalmic examinations including optical biometry, cycloplegic autorefraction and spectral-domain ocular coherence tomography. MAIN OUTCOME MEASURES: Retinal nerve fibre layer thickness in 16 radial sections, cycloplegic spherical equivalent, AL. RESULTS: The mean (SD) average RNFL thickness was 102.01(8.02) µm. The average RNFL thickness decreased with smaller disc area (r = 0.18, R2 = 0.03, P < 0.0001), bigger cup area (r = -0.11, R2 = 0.01, P < 0.0001), smaller rim area (r = 0.28, R2 = 0.08, P < 0.0001), smaller nerve head volume (r = 0.27, R2 = 0.07, P < 0.0001), longer AL (r = -0.15, R2 = 0.02, P < 0.0001) and a negative spherical equivalent (r = 0.11, R2 = 0.01, P < 0.0001). Hyperopic children had a thicker RNFL than emmetropic children [102.45(8.13) µm vs. 100.81 (7.18) µm, P < 0.001]. Myopic children had thinner RNFL than emmetropic children [99.17 (7.69) µm vs. 100.81 (7.18) µm, P < 0.05]. CONCLUSION: Retinal nerve fibre layer thickness decreased with increasing AL, higher myopia, bigger cup area, smaller disc and rim area, and a smaller nerve head volume, but the coefficient of determination for all these associations was small. The RNFL in myopes was significantly thinner than emmetropes or hyperopes, but with small absolute differences. The study provides RNFL values for healthy 7-year-old Chinese children. Follow up of this cohort to observe the change of RNFL thickness with myopia and possible change in detected associations with age is planned.

Atropine slows myopia progression more in Asian than white children by meta-analysis.

PURPOSE: To conduct a meta-analysis on the effects of atropine in slowing myopia progression and to compare Asian and white children and randomized controlled trials (RCTs) and observational studies. METHODS: Randomized controlled trials and observational studies that assessed the effects of all concentrations of atropine in slowing myopia progression in children were searched from MEDLINE, EMBASE, and the Cochrane Library up to April 2013. Jadad scoring was used to evaluate the quality of RCTs, and the Newcastle-Ottawa Scale was used for observational studies. RESULTS: Four RCTs and seven cohort studies (a kind of observational study) with 1815 children aged 5 to 15 years were included. The children had a baseline refraction of -0.50 to -9.75 diopters (D) and were followed up for 22.0 months (range, 12.0 to 36.5 months). The weighted mean differences in myopia progression in RCTs and cohort studies of Asian children were 0.55 D per year (p < 0.01) and 0.54 D per year (p < 0.001), respectively, and 0.35 D per year (p = 0.01) in cohort studies of white children. Compared with placebo, the risk of fast myopia progression (>1.0 D per year) using atropine was significantly decreased in both RCTs (odds ratio [OR], 0.14; p < 0.01) and cohort studies (OR, 0.08; p < 0.01), and the benefit of slow myopia progression (<0.50 D per year) using atropine was significantly increased in both RCTs (OR, 6.73; p < 0.01) and cohort studies (OR, 22.10; p < 0.01). CONCLUSIONS: Atropine could significantly slow myopia progression in children, with greater effects in Asian than in white children. Randomized controlled trials and cohort studies provided comparable effects.

Effects of Dexmedetomidine Added to Ropivacaine in Ultrasound-Guided Continuous Pericapsular Nerve Group Block Among Elderly Patients Undergoing Total Hip Arthroplasty.

Total hip arthroplasty (THA) is a highly effective intervention for addressing hip joint issues, yet managing perioperative pain remains a significant challenge. In this study, we aimed to investigate the impact of supplementing ropivacaine with dexmedetomidine in ultrasound-guided continuous pericapsular nerve group block (PENGB) among elderly patients undergoing THA. We conducted a retrospective analysis involving 112 elderly patients who underwent THA. These patients were divided into two groups: the Control group, receiving ropivacaine alone, and the DEX group, receiving ropivacaine combined with dexmedetomidine. We evaluated various parameters including hemodynamic data, postoperative pain levels assessed using the Visual Analog Scale, cognitive status measured with the Montreal Cognitive Assessment, and serum markers (S100ß and GFAP). Our findings revealed that the DEX group exhibited improved stability in blood pressure and oxygen saturation following surgery. Moreover, patients in the DEX group reported significantly lower levels of pain at 6 and 12 hours postsurgery, with a prolonged duration of pain relief. Furthermore, dexmedetomidine administration was associated with preserved cognitive function during the early postoperative period. Analysis of serum markers suggested potential cognitive protection conferred by the addition of dexmedetomidine. Overall, our study underscores the multifaceted benefits of incorporating dexmedetomidine into ropivacaine-based PENGB for elderly THA patients.

Structural prior-driven feature extraction with gradient-momentum combined optimization for convolutional neural network image classification.

Recent image classification efforts have achieved certain success by incorporating prior information such as labels and logical rules to learn discriminative features. However, these methods overlook the variability of features, resulting in feature inconsistency and fluctuations in model parameter updates, which further contribute to decreased image classification accuracy and model instability. To address this issue, this paper proposes a novel method combining structural prior-driven feature extraction with gradient-momentum (SPGM), from the perspectives of consistent feature learning and precise parameter updates, to enhance the accuracy and stability of image classification. Specifically, SPGM leverages a structural prior-driven feature extraction (SPFE) approach to calculate gradients of multi-level features and original images to construct structural information, which is then transformed into prior knowledge to drive the network to learn features consistent with the original images. Additionally, an optimization strategy integrating gradients and momentum (GMO) is introduced, dynamically adjusting the direction and step size of parameter updates based on the angle and norm of the sum of gradients and momentum, enabling precise model parameter updates. Extensive experiments on CIFAR10 and CIFAR100 datasets demonstrate that the SPGM method significantly reduces the top-1 error rate in image classification, enhances the classification performance, and outperforms state-of-the-art methods.

Microbial mechanisms in nitrogen fertilization: Modulating the re-mobilization of clay mineral-bound cadmium in agricultural soils.

Soil cadmium (Cd) can affect crop growth and food safety, and through the enrichment in the food chain, it ultimately poses a risk to human health. Reducing the re-mobilization of Cd caused by the release of protons and acids by crops and microorganisms after stabilization is one of the significant technical challenges in agricultural activities. This study aimed to investigate the re-mobilization of stabilized Cd within the clay mineral-bound fraction of soil and its subsequent accumulation in crops utilizing nitrogen ammonium nitrogen (NH4+-N) and nitrate nitrogen (NO3--N), at 60 and 120 mg kg-1. Furthermore, the study harvested root exudates at various growth stages to assess their direct influence on the re-mobilization of stabilized Cd and to evaluate the indirect effects mediated by soil microorganisms. The results revealed that, in contrast to the NO3--N treatment, the NH4+-N treatment significantly enhanced the conversion of clay mineral-bound Cd in the soil to NH4NO3-extractable Cd. It also amplified the accumulation of Cd in edible amaranth, with concentrations in roots and shoots rising from 1.7-6.0 mg kg-1 to 4.3-9.8 mg kg-1. The introduction of NH4+-N caused a decrease in the pH value of the rhizosphere soil and stimulated the production and secretion organic and amino acids, such as oxalic acid, lactic acid, stearic acid, succinic acid, and l-serine, from the crop roots. Furthermore, compared to NO3--N, the combined interaction of root exudates with NH4+-N has a more pronounced impact on the abundance of microbial genes associated with glycolysis pathway and tricarboxylic acid cycle, such as pkfA, pfkB, sucB, sucC, and sucD. The effects of NH4+-N on crops and microorganisms ultimately result in a significant increase in the re-mobilization of stabilized Cd. However, the simulated experiments showed that microorganisms only contribute to 3.8-6.6 % of the re-mobilization of clay mineral-bound Cd in soil. Therefore, the fundamental strategy to inhibit the re-mobilization of stabilized Cd in vegetable cultivation involves the regulation of proton and organic acid secretion by crops.

Comparison of trial lens and computer-aided fitting in orthokeratology: A multi-center, randomized, examiner-masked, controlled study.

PURPOSE: To compare the efficacy and safety between traditional lens fitting and computer-aided fitting methods for orthokeratology (OrthoK) in the Chinese population. METHODS: A multi-center, examiner-masked, randomized controlled study was conducted with a one-year follow-up period, enrolling 280 participants with spherical equivalent (SE) ranging from -0.5D to -4.0D. Participants were assigned to either the computer-aided orthokeratology fitting group (trial group) or the traditional lens fitting group (control group) using stratified randomization based on age (8 to 13 years, 13 to 18 years, and ≥ 18 years) to ensure a minimum of 30 cases in each sub-age group. Ocular examinations included visual acuity, objective and subjective refraction, corneal endothelial cell density, corneal topography, intraocular pressure, axial length, and ocular health assessment. Successful lens-correction was defined as the residual refraction with the OK lens, which should not exceed ± 0.5D, and/or an uncorrected visual acuity of no worse than 0.1 logMAR. Statistical analysis involves t-tests, analysis of variance, and Chi-squared tests. RESULTS: 215 subjects were included in the statistical analysis (109 in the trial group and 106 in the control group). In both groups, compared to baseline data, the uncorrected visual acuity (UCVA) improved significantly, with SE reduced and central corneal curvature flattened greatly after wearing OrthoK lens (P < 0.05 for all). Compared to the control group, the trial group exhibited a higher successful rate in correcting UCVA (93.6 % vs. 84.0 %, P = 0.03) and slightly better correction in refraction (77.1 % vs. 66.0 %, P = 0.07) at 1-month follow-up. However, no significant differences were observed in the axial length elongation, corneal changes, or the incidence of adverse events between the two groups. CONCLUSION: These findings indicate the higher efficiency and slightly better performance in correcting myopia and improving UCVA of computer-aided lens fitting approach compared to the traditional one, but similar outcomes in controlling axial elongation.

Increased risk of heavy metal accumulation in mangrove seedlings in coastal wetland environments due to microplastic inflow.

The recovery phase of mangrove seedlings in coastal wetland ecosystems can be negatively affected by exposure to external pollutants. This study aimed to investigate the impact of microplastics (MPs) influx, specifically polystyrene (PS) and polymethyl methacrylate (PMMA), on the growth of Aegiceras corniculatum seedlings and their accumulation of heavy metals (HMs). PS and PMMA significantly increased HMs accumulation (up to 21.0-548%), particularly in the roots of seedlings, compared to the control treatment (CK). Additionally, elevated activities of malondialdehyde and catalase enzymes were observed in the leaves of seedlings, while peroxidase enzyme activity decreased. Topological analysis of the root sediment microbiota coexistence network revealed that the modularization data increased from 0.69 (CK treatment) to 1.07 (PS treatment) and 5.11 (PMMA treatment) under the combined stress of MPs and HMs. This suggests that the introduction of MPs intensifies microbial modularization. The primary cause of increased HMs accumulation in plants is the MPs input, which influences the secretion of organic acids by plants and facilitates the shift of HMs in sediment to bioavailable states. Furthermore, changes in microbial clustering may also contribute to the elevated HMs accumulation in plants. This study provides valuable insights into the effects of external pollutants on mangrove seedlings and offers new perspectives for the preservation and restoration of mangrove coastal wetlands.