Assessment of the anterior scleral thickness in central serous chorioretinopathy patients by optical coherence tomography.

PURPOSE: To assess the anterior scleral thickness (AST) and describe the presence of a visible supraciliary space (SCS) in central serous chorioretinopathy (CSC) patients by swept-source optical coherence tomography (SS-OCT). STUDY DESIGN: Cross-sectional comparative study. MATERIAL AND METHODS: Three groups were studied: 1) 64 eyes of 54 patients with CSC with persistent subretinal fluid (SRF); 2) 42 fellow eyes of CSC patients without SRF; 3) 65 eyes of 65 controls matched by age, sex and axial length (AL). The AST was measured in the temporal and nasal quadrants at 0, 1, and 2 mm from the scleral spur by SS-OCT. The presence of a visible SCS was also assessed. RESULTS: No differences were observed in the AST0 among the three groups (p≥ 0.665). The temporal AST1 was significantly thicker in the CSC group (530.3 ±67.1 µm) than in the controls (505.5 ±73.9; p=0.041). Mean AST2 was also thicker in the CSC group and the fellow eyes both for the temporal (519.4 ±89.1 µm and 519.8 ±98.5 µm respectively) and nasal quadrants (564.2 ±124.9 µm and 570.5 ±131.0 µm) than in the controls (450.1 ±76.8 and 473.3 ±111.6 µm) (all p≤0.001). A visible SCS was detected in the eyes of 8 CSC patients, in 4 fellow eyes and only in 1 control eye. CONCLUSIONS: AST measured by SS-OCT was significantly greater in CSC eyes than in healthy eyes. Also, a visible SCS was detected in CSC eyes. Thus, thicker sclera in CSC eyes could be associated with the physiopathology of this disease.

Disparity in elevational shifts of upper species limits in response to recent climate warming in the Qinling Mountains, North-central China.

Examinations of upper elevational distribution limits of tree species can provide indications of how subalpine vegetation responds to the ongoing climate warming. Dynamics and functional mechanisms of elevational treelines are reasonably well understood, while explanations for tree species-specific upper elevational distribution limits below the treeline still remain unclear. In this study, we used a state-of-the-art dendroecological approach to reconstruct long-term changes of species-specific upper elevational distribution limits of different plant functional type (i.e., light-demanding deciduous coniferous larch at treeline, shade-tolerant evergreen coniferous fir and shade-intolerant deciduous broad-leaved birch below treeline) along elevational gradients in the Qinling Mountains of north-central China. Over the past three centuries, all the upper species limits shifted upslope as a response to climate warming. However, the warming-induced upslope migrations showed substantial differences, displaying the maximum upward shift of larch with an average elevation of 24.7 m during the past century, while only a slight advance of the non-treeline tree species. The disparity in elevational advance of upper species limits might be attributable to the presence of interspecific competition, showing that the non-treeline tree species experienced intermediate interspecific competition while the treeline tree species experienced no interspecific competition. Thus, our findings suggested that in addition to climate warming, biotic interaction may contribute much to shaping the species-specific upper limit dynamics. This study not only enhanced mechanistic understanding of long-term species-specific upper elevational distribution limit changes, but also highlighted the jointly effects of rising temperatures and species interactions on subalpine vegetation dynamics.

The Effect of the Full Coverage of Essential Medicines Policy on Utilization and Accessibility of Primary Healthcare Service for Rural Seniors: A Time Series Study in Qidong, China.

Background: Since 2015, in order to handle the increasing prevalence of age-related diseases and escalating health expenditures arising from the aging population, the full coverage of essential medicines (FCEMs) policy for rural seniors has been implemented in primary healthcare institutions of Qidong County of Jiangsu, China. The purpose of this study is to examine the long-term effects of the introduction of FCEMs' policy on the utilization and accessibility of primary healthcare service for elderly beneficiaries. Methods: The retrospective study was conducted in Qidong County in the Jiangsu province, China. A 47-month longitudinal dataset involving 91,444 health insurance claims records of inpatients aged 70 and older in primary healthcare institutions was analyzed. Changes in health service utilization (average length of stay), patient copayments (out-of-pocket expenses), New Rural Cooperative Medical System (NRCMS) reimbursement rate and daily hospitalization costs per patient were analyzed using interrupted time series analysis. Augment Dicky-Fuller unit root method was used to test the stationarity of the series alongside the Durbin Watson method to test autocorrelation. Results: Average length of stay increased at 0.372 bed-days per month before the implementation of FCEMs policy, whereas the increasing trend was slowed down at 0.003 bed-days per month after the implementation of FCEMs policy (p < 0.001). The average out-of-pocket expenses increased by 38.035 RMB monthly in pre-implementation of the policy period, but it decreased at the rate of 5.180 RMB per month after the implementation of the FCEMs policy (p = 0.006). The NRCMS reimbursement rate increased at 0.066% per month in pre-implementation of policy and the increasing trend was sharper at 0.349% in post-implementation of policy (p = 0.135). The daily hospitalization costs per patient decreased by 6.263 RMB (p = 0.030) per month, whereas it increased at the rate of 3.119 RMB (p = 0.002) per month afterwards. Conclusions: Based on interrupted time series analyses, we concluded that FCEMs policy was associated with positive changes of average LOS and average OOP expenses. The FCEMs policy has alleviated the financial burden of the rural seniors and slightly improved the efficiency of primary health service utilization. However, it had no positive effect on daily hospitalization costs. Therefore, in the general framework of FCEMs policy, the Chinese health policy-maker should take necessary supporting measures to curb climbing hospitalization expenditures and promote the rational drug use in primary healthcare institutions.

[Dynamics of recent cultivated land in Zhejiang Province and relevant driving factors].

Through the human-computer interactive interpretation of the 2000, 2005, and 2008 remote sensing images of Zhejiang Province with the help of RS and GIS techniques, the dynamic database of cultivated land change in the province in, 2000-2008 was established, and the driving factors of the cultivated land change were analyzed by ridge regression analysis. There was a notable cultivated land change in the province in 2000-2008. In 2000-2005 and 2005-2008, the annual cultivated land change in the province arrived -1.42% and -1.46%, respectively, and most of the cultivated land was changed into residential and industrial land. Non-agricultural population rate, real estate investment, urban green area, and orchard area were thought to be the main driving factors of the cultivated land change in Zhejiang Province, and even, in the developed areas of east China.

Laser lipolysis used to treat localized adiposis: a preliminary report on experience with Asian patients.

BACKGROUND: Localized deposits of fat (adiposis) located in the face, chin, neck, and arms usually are more compact and difficult to treat using conventional liposuction. It is necessary to find an effective approach for this type of localized adiposis. This study aimed to investigate the clinical application of laser lipolysis for the treatment of localized adiposis in Asian patients. METHODS: In this study, 35 patients with localized adiposis were treated by laser lipolysis. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser energy was transferred through an optic fiber into the adipose tissue. The optimal energy and frequency of the laser were controlled precisely to melt and destroy the adipose tissue without damage to the skin and deeper tissues. The histologic study of treated adiposis tissues, the postoperation reaction, and the clinical results were observed and studied. RESULTS: After laser lipolysis, the localized adipose tissues were liquefied effectively, and the compact fibrous tissues were broken down into a looser structure. Bleeding was noted to be less than with conventional liposuction due to the coagulation of capillary vessels and the thermal effect of the laser. Laser lipolysis caused less edema, petechiae, and other postoperative complications, producing rapid recovery and satisfactory results. CONCLUSION: The Nd:YAG laser has a definite lipolysis effect on compact adipose tissue and is a more effective approach for the treatment of localized adiposis than conventional liposuction.