Impact of Refractive Status on Presbyopia Progression among Patients with Presbyopia.

PURPOSE: To explore the impact of refractive status on presbyopia progression among patients with presbyopia. METHODS: This retrospective observational study included patients with presbyopia who visited the Seventh Affiliated Hospital of Sun Yat-sen University and Shenzhen Polytechnic Medical College between May 2018 and August 2022. The amplitude of accommodation (AMP) and near addition power (ADD) at 6 months and 1 year were collected. RESULTS: A total of 103 patients with presbyopia were included in this study: 42 patients with myopia, 23 patients with emmetropia, and 38 patients with hyperopia. There were significant differences in ΔAMP(6-month) and ΔADD(6-month) among patients with different refractive statuses, and the values of emmetropic patients and hyperopic patients were higher than in myopic patients (all P < 0.001). The ΔAMP(1-year) and ΔADD(1-year) of hyperopic patients were significantly higher than in emmetropic patients and myopic patients (all P < 0.001). The ΔADD(1-year) of emmetropic patients was greater than in myopic patients (P = 0.045), but there were no significant differences in ΔAMP(1-year) between patients with emmetropia and myopia (P = 0.090). CONCLUSIONS: The progression of presbyopia in hyperopic patients was relatively more significant than for emmetropia, followed by myopia. The prescription of presbyopia glasses might need to be replaced more frequently in patients with hyperopia.

Dynamic decline of lymphocytes predicts extracorporeal membrane oxygenation-related infections: a retrospective observational study.

Background: Limited data are available regarding the current microbiological characteristics of extracorporeal membrane oxygenation (ECMO)-related infections in intensive care units (ICUs) in China. This retrospective study aimed to determine the epidemiology, risk factors and impact on the outcome of ECMO-related infections. Methods: A retrospective observational study from January 2014 to December 2019 was performed, and adult patients receiving ECMO support for more than 48 hours were included in this study. The primary outcome was the incidence rate of ECMO-related infection. Clinical data were recorded, and risk factors associated with an increased risk of ECMO-related infection were analyzed. Results: A total of 174 adult patients who received ECMO and underwent ECMO for 1,670 days were included in this study. Forty-six patients (26.4%) developed ECMO-related infections, corresponding to 27.5 first episodes/1,000 ECMO days. The most common ECMO-related infection observed was ventilator-associated pneumonia (VAP). Infected patients had longer durations of mechanical ventilation {20.2 [interquartile range (IQR), 12.6, 30.7] vs. 9.0 (IQR, 5.8, 14.7) days, P<0.001}, ECMO support [11.6 (IQR, 8.1, 17.3) vs. 7.6 (IQR, 5.6, 9.7) days, P<0.001] and hospital stays (28.2±20.7 vs. 22.0±15.6 days, P<0.001). The factors independently associated with ECMO-related infection were a dynamic decrease in lymphocyte count [adjusted odds ratio (OR) =3.578, 95% confidence interval (CI): 2.175-4.906, P<0.001] and ECMO duration (adjusted OR =1.207, 95% CI: 1.096-1.330, P<0.001). Compared to patients without infection, infected patients had greater hospital mortality (39.1% vs. 78.3%, P<0.001) and 90-day mortality (40.6% vs. 87.0%, P<0.001). ECMO-related infections were associated with worse outcomes (adjusted Kaplan-Meier curve, log rank test P<0.001). Conclusions: Patients supported by ECMO had a high risk of developing ECMO-related infection. The most common ECMO-related infection observed was VAP. A dynamic decrease in lymphocyte counts was significantly associated with an increased risk of ECMO-related infection.

Australia's Tinderbox Drought: An extreme natural event likely worsened by human-caused climate change.

We examine the characteristics and causes of southeast Australia's Tinderbox Drought (2017 to 2019) that preceded the Black Summer fire disaster. The Tinderbox Drought was characterized by cool season rainfall deficits of around -50% in three consecutive years, which was exceptionally unlikely in the context of natural variability alone. The precipitation deficits were initiated and sustained by an anomalous atmospheric circulation that diverted oceanic moisture away from the region, despite traditional indicators of drought risk in southeast Australia generally being in neutral states. Moisture deficits were intensified by unusually high temperatures, high vapor pressure deficits, and sustained reductions in terrestrial water availability. Anthropogenic forcing intensified the rainfall deficits of the Tinderbox Drought by around 18% with an interquartile range of 34.9 to -13.3% highlighting the considerable uncertainty in attributing droughts of this kind to human activity. Skillful predictability of this drought was possible by incorporating multiple remote and local predictors through machine learning, providing prospects for improving forecasting of droughts.

Intervention on Externalizing Problems of Undercontrolled Personality Types in Primary School Students.

Three personality types (resilient, overcontrolled, and undercontrolled) have been repeatedly verified across different languages and cultures, different personality models, and different stages of development. Undercontrollers are socially maladapted types with high impulsivity and low self-control. Research shows they are at risk for externalizing problems, such as aggressiveness, impulsivity, and antisocial behavior. The aim of this study was to develop an intervention to reduce externalizing problems of undercontrolled personality types in primary school students. Participants were 69 undercontrolled primary school students from two primary schools in North China. The experimental group underwent 14 weeks of systematic experiential mental health activities, while the control group performed typical daily classroom activities. Personality and externalizing problem behaviors were measured before the intervention, at the end of the intervention, and 4 months post-intervention. The results showed that the intervention significantly reduced the level of externalizing problems of undercontrolled primary school students. The effects of the intervention were maintained at the 4-month follow-up. This study provides some reference and suggestions on how to intervene in the externalizing problem behaviors of undercontrolled primary school students.

Unexpected intraoperative hypercapnia due to undetected expiratory valve dysfunction--a case report.

The normally functioning of anesthetic circle system depends mainly on the integrity of both inspiratory and expiratory unidirectional valves which keep the inspiratory gas will not be contaminated by the expired CO2. In case there is a leakage defect in one or both of these valves, i.e. inability to keep tightly closed during the cycle, retrograde gas flow may happen and the exhaled CO2 may get into the inspiratory limb, resulting in rebreathing and hypercapnia with disastrous aftermath. Here we report a rather rare incident of unrecognized expiratory valve insufficiency that was not detected before anesthesia in a 40-year-old female patient who developed intraoperative hypercapnea during general anesthesia with mechanical ventilation. Discussions on the causes, management, and prevention of hypercapnia due to respiratory valve dysfunction are presented.