LONGITUDINAL CHANGES IN CHOROIDAL AND RETINAL THICKNESSES IN CHILDREN WITH MYOPIC SHIFT.

PURPOSE: To elucidate the development of the choroid and retina in children, and to explore changes in these during myopic shift. METHODS: A total of 118 children aged 7 to 12 years participated in this 1-year longitudinal study. Children underwent several examinations at baseline and follow-up, including cycloplegic refraction, axial length measurement, and swept-source optical coherence tomography. Thickness changes in the choroid and retina were compared among children with or without myopic shift. RESULTS: Eighty-eight children (74.6%) developed a myopic shift after 1 year, and their central foveal choroid was significantly attenuated (P < 0.01). No significant change was observed in choroids of children without myopic shift (P = 0.83). Choroidal thickness decreased in all subfields during myopic shift, whereas the thickness of the retinal layers increased or were unchanged in most subfields. Axial length increase and central foveal choroidal thinning were associated with myopic shift (R = 0.157, P < 0.01), but axial length increase was not significantly related to choroidal thinning (P > 0.05). CONCLUSION: Choroidal thinning occurs early in myopic progression. Axial length increase and choroidal thinning are independently associated with myopic shift.

Bayesian analysis of physiologically based toxicokinetic (PBTK) modeling for pentachlorophenol exposure in pregnant women.

Pentachlorophenol (PCP) is a persistent organic compound that is widely present in the environment. The estimation of internal exposure levels for a given external exposure using toxicokinetic models is key to the human health risk assessment of PCP. The present study developed a physiologically based multicompartmental pharmacokinetic (PBTK) model to describe and predict the behavior of pentachlorophenol (PCP) in an organism. The model consists of stomach, intestines, adipose tissue, kidneys and fast- and poorly perfused tissues that are interconnected via blood circulation. We constructed a PBTK model of PCP in rats and extrapolated it to human dietary PCP exposure. The toxicokinetic data of PCP in human tissues and excreta were obtained from the published literature. Based on the collected PCP dietary survey and internal exposure data of pregnant women in Shanghai, Bayesian statistical analysis was performed for the model using Markov chain Monte Carlo (MCMC) simulation. The posterior distributions of the sensitive parameters were estimated, and the model was parameter optimized and validated using the pregnant women's test dataset. The results showed that the root mean square error (RMSE) improved 37.3% compared to the original model, and a systematic literature search revealed that the optimized model achieved acceptable prediction results for other datasets in China. A PCP metabolism model based on the exposure characteristics of pregnant women in China was constructed in the present study. The model provides a theoretical basis for the study of PCP toxicity and risk assessment.

Development of the retina and its relation with myopic shift varies from childhood to adolescence.

AIMS: To elucidate the influence of age and myopic shift on retinal development. METHODS: This 1-year longitudinal study included 769 participants aged 6-17 years. Cycloplegic refraction, axial length and swept-source optical coherence tomography were examined at baseline and follow-up. The thickness changes in the retina, ganglion cell complex (GCC) and outer retinal layers (ORL) in the macular region were calculated, and their relation with age and myopic shift was analysed with multiple linear regression analysis. RESULTS: The thickness of the central foveal retinal layers was increased in children (<10 years) but unchanged or decreased in adolescents (>13 years). The thickness changes in the retina, GCC and ORL decreased with age (r=-0.24,-0.23, -0.15, respectively, all p<0.01). Multiple regression analysis showed that the changes in central foveal retinal thickness (RT) and GCC thickness were independently associated with age and baseline spherical equivalent (SE), while the changes in ORL thickness were associated with age and SE changes. In children 8-9 years, a greater increase was observed in central foveal ORL thickness in those with no myopic shift (p<0.01). The thickness of the most parafoveal and perifoveal retinal layers was less increased or more decreased in children <9 years with myopic shift (p<0.05). CONCLUSIONS: Retinal development and its relation with myopic shift varies from childhood to adolescence. Myopia-related retinal thinning may result from less increase in the RT in childhood rather than a decrease in RT in adolescents. Children under 9 years old could be at a critical age for future myopia-related retinal thinning.

The effects on pain and disability of traditional Chinese non-pharmacological therapy for knee osteoarthritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic joint disease with serious health economic burden. More and more randomized controlled trials have indicated that traditional Chinese non-pharmacological therapy, including acupuncture, Tai Chi, Tuina, etc can significantly improve pain and physical function of patients with KOA. However, the effects of traditional Chinese non-pharmacological therapy for KOA remain controversial. Most previous systematic reviews did not focus on the effects of traditional Chinese non-pharmacological therapy for KOA as a whole. In Chinese community hospital, however, acupuncture, Tuina, and Tai Chi are usually in the management of KOA as whole-body treatment. METHODS: The electronic databases (PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, China Knowledge Resource Integrated Database, and Wanfang Data) will be searched. The search will include all documents from their inception to December 2021. Two reviewers independently extracted the data and assessed the risk of bias by the Cochrane Risk of Bias Tool for randomized controlled trials. The meta-analysis will be conducted with a random or fixed effect model to calculate the standardized mean difference and 95% confidence intervals based on different heterogeneity using the Review Manager Version 5.3 software. The heterogeneity will be examined by Higgins I2 statistic. The subgroup analysis will be conducted based on different types of traditional Chinese non-pharmacological therapy and different outcomes. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation. RESULTS: The current systematic review and meta-analysis will be conducted to investigate the effects of traditional Chinese non-pharmacological therapy in the management of KOA. The main outcomes will include pain and disability. The secondary outcomes will include quality of life and adverse events. CONCLUSION: To provide evidence for evidence-based medicine and clinical researchers to choose more effective traditional Chinese non-pharmacological therapy for KOA. INPLASY REGISTRATION NUMBER: INPLASY202170098.

Retinal oxygen saturation in 1461 healthy children aged 7-19 and its associated factors.

PURPOSE: The aim of the present study was to investigate age-specific normative retinal oxygen saturation values and explore the associated factors in healthy Chinese school-aged children with different refractive statuses. DESIGN: Population-based observational cross-sectional study. METHODS: Children aged 7-19 years were enrolled. Each participant underwent a series of comprehensive ocular examinations, including axial length (AL), cycloplegic refraction and Oxymap T1 imagery following cycloplegia. The acquired oximetry images were measured, and the values of the retinal oxygen saturation parameters were calculated. The independent factors of the retinal oxygen saturation were analysed using multiple linear regression. The oxygen saturation of retinal arteries (SaO2 ) and veins (SvO2 ) as well as the differences between the arteries and veins (AVD) were measured as the main outcomes. RESULTS: In total, 1461 participants were included in the study. The mean age of the participants was 12.1 ± 3.2 years, and 53.0% were boys. The mean SaO2 , SvO2 and AVD values were 83.7 ± 6.4%, 50.1 ± 5.4% and 33.6 ± 5.4%, respectively, and the values increased with age. Girls had higher SvO2 and lower AVD than boys (p < 0.05). The Pearson correlation coefficients among spherical equivalent (SE) and SaO2 , SvO2 and AVD were -0.372, -0.203 and -0.240, respectively (all p < 0.001), while the correlations between AL and SaO2 , SvO2 and AVD were 0.276, 0.106 and 0.221, respectively (all p < 0.001). The myopia group had significantly higher SaO2 , SvO2 and AVD than the emmetropia and hyperopia groups (p < 0.001), but the high myopia group had lower SaO2 and SvO2 than the moderate myopia group. When age, gender, body mass index (BMI), intraocular pressure (IOP) and axial length (AL) were included as factors in the multiple regression, older age was associated with higher SaO2 , SvO2 and AVD, while longer AL was associated with higher SaO2 and AVD. Gender was an independent factor predicting SvO2 , while gender and BMI were the independent factors predicting AVD. Age explained more variance than AL in SaO2 , SvO2 and AVD. CONCLUSIONS: Our population-based study provides age-specific profiles of retinal oxygen saturation in Chinese children and adolescents. Older age and longer AL were important independent factors of increased retinal oxygen saturation.

Macular Ganglion Cell-Inner Plexiform Layer, Ganglion Cell Complex, and Outer Retinal Layer Thicknesses in a Large Cohort of Chinese Children.

Purpose: The purpose of this study was to describe the normative values, distribution patterns, and correlated factors of macular ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex (GCC), and outer retinal layer (ORL) thicknesses in Chinese children. Methods: A sample of 3000 healthy children with different refractive status aged 6 to 19 years was consecutively examined. Demographics were recorded, and a comprehensive ophthalmic examination including refractive error and axial length (AL) was taken from all participants. The GCIPL, GCC, and ORL thicknesses were measured using swept source-optical coherence tomography (OCT), and multiple linear regression was used to determine which factors were associated with the thickness of each layer. Results: The average thickness was 77.00 ± 4.78 µm (95% confidence interval [CI]: 69.56-84.56 µm) in the GCIPL, 107.68 ± 5.95 µm (95% CI: 98.45-117.21 µm) in the GCC, and 178.57 ± 9.02 µm (95% CI: 164.33-192.56 µm) in the ORL. Multiple regression analysis indicated that GCIPL thickness was associated with sex (ß = 0.168, P < 0.001), age (ß = 0.126, P < 0.001), axial length (ß = -0.181, P < 0.001), and refractive error (ß = 0.233, P < 0.001). Age (ß = 0.154, P < 0.001), sex (ß = 0.102, P < 0.001), and refractive error (ß = 0.149, P < 0.001) were associated independently with GCC thickness after adjusting for the other factors. Furthermore, age (ß = 0.100, P < 0.001), sex (ß = 0.163, P < 0.001), AL (ß = -0.283, P < 0.001), and refractive error (ß = 0.207, P < 0.001) were the independent factors associated with ORL thickness. Conclusions: The present study established a normative pediatric database for macular layer thicknesses in healthy Chinese children, advancing the ability of OCT in diseases diagnosis and monitoring among children.

Distribution of scleral thickness and associated factors in 810 Chinese children and adolescents: a swept-source optical coherence tomography study.

PURPOSE: To explore the subfoveal thickness of sclera (SST), choroid (SCT) and retina (SRT) as well as their relationship in healthy Chinese children with varying levels of refractive error. METHODS: A total of 810 healthy Chinese schoolchildren and adolescents underwent a series of comprehensive ocular examinations, as well as swept-source optical coherence tomography (OCT) after induced cycloplegia. The thicknesses of the sclera, choroid and retina below the central fovea were measured manually, and each measurement was compared across different refractive statuses. Independent factors associated with the thickness of each layer were analysed. RESULTS: The mean SST, SCT and SRT were 524 ± 57 µm, 195 ± 49 µm and 224 ± 19 µm, respectively. The SSTs and SCTs of myopes were significantly thinner than those of emmetropes and hyperopes (all p < 0.001). Although the choroid seemed to be thicker in hyperopes (225 ± 46 µm) than in emmetropes (211 ± 45 µm), no statistically significant difference was observed between emmetropes and hyperopes in the sclera and choroid. Thinner SSTs and SCTs were associated with greater levels of myopia, whereas the SRT was similar in children with different myopic levels. SST (p < 0.001) and SCT (p = 0.003) as well as age (p < 0.001), sex (p < 0.001) and axial length (p < 0.001) were independently associated with spherical equivalent refraction (SER). Older age (p = 0.013), myopic-shifted SER (p < 0.001), thicker SCT (p < 0.001) and thinner SRT (p = 0.012) were independently associated with a thinner SST. CONCLUSION: The subfoveal sclera and choroid were thinner in myopes than in emmetropes and hyperopes, while the retina remains constant. Age, refractive error and choroidal and retinal thicknesses are related to subfoveal scleral thickness.

Choroidal Thickness in 3001 Chinese Children Aged 6 to 19 Years Using Swept-Source OCT.

The purpose of the cross-sectional study is to describe the values and distribution of choroidal thickness and to explore its related factors, especially age, in Chinese children. A total of 3001 Chinese school children aged 6 to 19 years underwent comprehensive ophthalmic examinations, including axial length and cycloplegic refraction. Choroidal thickness was measured by swept-source optical coherence tomography (SS-OCT). There was a greater difference in the more central regions between the myopes and emmetropes. Multiple regression analysis was performed to determine the associated factors of choroidal thickness. The results demonstrated that age was independently positively related to choroidal thickness for emmetropes (ß = 3.859, p < 0.001), and mild myopes with spherical equivalent greater than -2.00 D (-1.25 D < spherical equivalent ≤ -0.50 D: ß = 3.476, p = 0.006; -2.00 D < spherical equivalent ≤ -1.25 D: ß = 3.232, p = 0.020). However, no significant relationship between age and choroidal thickness was found in children with spherical equivalent ≤ -2.00 D, suggesting that the protective effect of physiologic choroidal growth with age against rapid axial elongation disappeared while axial elongation becomes the dominant determinant of choroidal thickness among children with myopia worse than -2.00 D.

Choroidal and Retinal Thickness in Children With Different Refractive Status Measured by Swept-Source Optical Coherence Tomography.

PURPOSE: To investigate the choroidal and retinal thickness in myopic, emmetropic, and hyperopic Chinese children by swept-source longer-wavelength optical coherence tomography. DESIGN: Cross-sectional study. METHODS: Two-hundred and seventy-six schoolchildren aged 7-13 years underwent comprehensive ophthalmic examinations, including cycloplegic refraction, and swept-source optical coherence tomography measurements. The thickness of the choroid, retina, ganglion cell layer, and nerve fiber layer were compared among children of different refractive status. The topographic variation and factors related to the thickness of the choroid and retinal layers were analyzed. RESULTS: Compared to emmetropic subjects, those with myopia had a significantly thinner choroid in all regions (P < .01), and hyperopic subjects had a thicker choroid in most regions (P < .05). The myopic retinas were thinner than those of emmetropic or hyperopic subjects in the superior parafoveal and all 4 perifoveal subfields (P < .05), but no other subfields differed significantly among different refractive groups (P > .05). The axial length and refractive diopters were independently related to central foveal choroidal thickness (R(2) = 0.17, P < .01), while age and intraocular pressure were independently associated with central fovea retinal (R(2) = 0.15, P < .01) and ganglion cell layer thicknesses (R(2) = 0.10, P < .01) after adjustment for other systematic and ocular factors. Central foveal choroidal and retinal thickness were unrelated in children of different refractive status (P > .05). CONCLUSIONS: Choroidal thickness, but not retinal thickness, correlated closely with axial length and refractive diopters in Chinese children. Choroid thinning occurs before retina thinning early in myopic progression.

Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3-10 Years in Shanghai, China.

PURPOSE: We assessed changes in age-specific prevalence of refractive error at the time of starting school, by comparing preschool and school age cohorts in Shanghai, China. METHODS: A cross-sectional study was done in Jiading District, Shanghai during November and December 2013. We randomly selected 7 kindergartens and 7 primary schools, with probability proportionate to size. Chinese children (n = 8398) aged 3 to 10 years were enumerated, and 8267 (98.4%) were included. Children underwent distance visual acuity assessment and refraction measurement by cycloplegic autorefraction and subjective refraction. RESULTS: The prevalence of uncorrected visual acuity (UCVA), presenting visual acuity, and best-corrected visual acuity in the better eye of ≤20/40 was 19.8%, 15.5%, and 1.7%, respectively. Among those with UCVA ≤ 20/40, 93.2% could achieve visual acuity of ≥20/32 with refraction. Only 28.7% (n = 465) of children with UCVA in the better eye of ≤20/40 wore glasses. Prevalence of myopia (spherical equivalent ≤-0.5 diopters [D] in at least one eye) increased from 1.78% in 3-year-olds to 52.2% in 10-year-olds, while prevalence of hyperopia (spherical equivalent ≥+2.0 D) decreased from 17.8% among 3-year-olds to 2.6% by 10 years of age. After adjusting for age, attending elite "high-level" school was statistically associated with greater myopia prevalence. CONCLUSIONS: The prevalence of myopia was lower or comparable to that reported in other populations from age 3 to 5 years, but increased dramatically after 6 years, consistent with a strong environmental role of schooling on myopia development.