Best-corrected visual acuity results facilitate molecular diagnosis of infantile nystagmus patients harboring FRMD7 mutations.

The visual function of patients with infantile nystagmus (IN) can be significantly decreased owing to constant eye movement. While, reaching a definitive diagnosis becomes a challenge due to genetic heterozygous of this disease. To address it, we investigated whether best-corrected visual acuity (BCVA) results can facilitate the molecular diagnosis of IN patients harboring FRMD7 mutations. 200 patients with IN from 55 families and 133 sporadic cases were enrolled. Mutations were comprehensively screened by direct sequencing using gene-specific primers for FRMD7. We also retrieved related literature to verify the results based on our data. We found that the BCVA of patients with IN harboring FRMD7 mutations was between 0.5 and 0.7, which was confirmed by data retrieved from the literature. Our results showed that BCVA results facilitate the molecular diagnosis of patients with IN harboring FRMD7 mutations. In addition, we identified 31 FRMD7 mutations from the patients, including six novel mutations, namely, frameshift mutation c.1492_1493insT (p.Y498LfsTer14), splice-site mutation c.353C > G, three missense mutations [c.208C > G (p.P70A), c.234G > A (p.M78I), and c.1109G > A (p.H370R)], and nonsense mutation c.1195G > T (p.E399Ter). This study demonstrates that BCVA results may facilitate the molecular diagnosis of IN patients harboring FRMD7 mutations.

Improvement in health-related quality of life with Botulinum toxin A injection in acquired superior oblique palsy.

Purpose: This study aimed to investigate the outcomes of Botulinum toxin A (BTA) injection into the inferior oblique (IO) muscle for the management of unilateral acute acquired superior oblique palsy (SOP) and to evaluate changes in health-related quality of life post-injection using the Adult Strabismus-20 (AS-20) questionnaire. Methods: A prospective cohort study was performed in patients with unilateral acute acquired SOP who received BTA injections. Four units of BTA were injected into the ipsilateral IO muscle. Ocular examinations were performed pre-and post-injection, including alignment, ocular movement, and cyclotorsion deviation. The patients' AS-20 questionnaire scores were analyzed. Results: A total of 21 patients with acute acquired SOP were included. The initial median vertical deviation was 5 PD (range 1-16), which was improved to 0 PD (range 0-10) at both 1 and 6 months post-injection (p < 0.001 and p < 0.001, respectively). The median torsional deviation was 7° (range 2-18) at baseline and resolved to 0 degrees (range -3-5) at the 1-month and 0° (range -2-7) at the 6-month follow-up (p < 0.001 and p < 0.001, respectively). There were significant increases in the overall score (OAS), psychosocial subscale score (PSS), and functional subscale score (FSS) from baseline values at both the 1-month (p < 0.001, p < 0.001, and p = 0.001, respectively) and 6-month follow-up (all p < 0.001). Conclusion: Injecting BTA into the ipsilateral IO muscle successfully resolved vertical and torsional deviations and significantly improved quality-of-life scores. Our findings show that BTA treatment, as an early treatment for acute acquired SOP, can help patients by significantly improving their quality of life.

Image-Guided Optical Coherence Tomography to Assess Structural Changes in Rodent Retinas.

Ocular diseases, such as age-related macular degeneration, glaucoma, retinitis pigmentosa, and uveitis, are always accompanied by retinal structural changes. These diseases affecting the fundus always exhibit typical abnormalities in certain cell types in the retina, including photoreceptor cells, retinal ganglion cells, cells in the retinal blood vessels, and cells in the choroidal vascular cells. Noninvasive, highly efficient, and adaptable imaging techniques are required for both clinical practice and basic research. Image-guided optical coherence tomography (OCT) satisfies these requirements because it combines fundus photography and high-resolution OCT, providing an accurate diagnosis of tiny lesions as well as important changes in the retinal architecture. This study details the procedures of data collection and data analysis for image-guided OCT and demonstrates its application in rodent models of choroidal neovascularization (CNV), optic nerve crush (ONC), light-induced retinal degeneration, and experimental autoimmune uveitis (EAU). This technique helps researchers in the eye field to identify rodent retinal structural changes conveniently, reliably, and tractably.

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial.

BACKGROUND: To assess the clinical effectiveness of orthoptic therapy in the postoperative stabilisation and rehabilitation of binocular function in children with intermittent exotropia (IXT) after surgery. METHODS: This was a prospective, parallel, randomised controlled trial. A total of 136 IXT patients (aged from 7 to 17 years) who had been successfully corrected at 1 month after surgery were enrolled in this study, and 117 patients (58 controls) completed the 12-month follow-up visit. The primary outcome was established as the proportion of patients with suboptimal surgical outcomes, which were defined as: (1) exodeviation ≥10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT), or (2) constant esotropia ≥6 PD at distance or near using SPCT, or (3) loss of 2 or more octaves of stereopsis from baseline. The secondary outcomes were the exodeviation at distance and near using the prism and alternate cover test (PACT), stereopsis, fusional exotropia control and convergence amplitude. RESULTS: The cumulative probability of suboptimal surgical outcome by 12 months was 20.5% (14/68) in the orthoptic therapy group and 42.6% (29/68) in the control group. There was a significant difference between these two groups (χ2 = 7.402, p = 0.007). Improvements in stereopsis, fusional exotropia control and fusional convergence amplitude were found in the orthoptic therapy group. A smaller exodrift was found in the orthoptic therapy group at near fixation (t = 2.26, p = 0.025). CONCLUSIONS: Early postoperative orthoptic therapy can effectively improve the surgical outcome as well as stereopsis and fusional amplitude.

Translating and evaluating the Chinese version of Pediatric Eye Questionnaire (PedEyeQ-CN) for children.

OBJECTIVES: To investigate the reliability and validity of Chinese version of the Pediatric Eye Questionnaire (PedEyeQ-CN) by testing ophthalmic patients in China. METHODS: The PedEyeQ (standard English version) was translated by local researchers. Children were asked to complete the Child section, and their parents the Proxy and Parent sections. 160 children (32 normal controls, 77 with refractive error, 48 with strabismus/amblyopia, 3 with other eye conditions) aged 5-11 years old, and one parent of each child were recruited. Cronbach's α and intraclass correlation coefficient were calculated to examine the reliability and test-retest reliability; the score differences between controls and patients were compared to examine the validity. RESULTS: The internal consistency (Cronbach's α ≥ 0.76) and test-retest reliability (r > 0.80) of PedEyeQ-CN were robust. Children with eye conditions had lower scores compared with children with normal vision (refractive error: 10 out of 13 domains, P ≤ 0.021; strabismus/amblyopia: all domains, P ≤ 0.015). Children with strabismus/amblyopia had lower scores compared with children with refractive error (two domains, P = 0.048, P = 0.001). Visual acuity was significantly correlated with functional vision (P = 0.005), but not significantly correlated with the eye-related quality of life (ER-QOL). CONCLUSIONS: The PedEyeQ-CN is a valuable tool for assessing the functional vision and ER-QOL of Chinese children and help us increase our understanding about the impact of eye conditions on children and their families.

Distinct arsenic uptake feature in rice reveals the importance of N fertilization strategies.

The environmental behavior of arsenic (As) is commonly affected by the biogeochemical processes of iron (Fe) and nitrogen (N). In this study, field experiments were conducted to explore As uptake in rice and As translation and distribution in As-contaminated iron-rich paddy soils after applying different forms of N fertilizers, including urea (CO(NH2)2), ammonium bicarbonate (NH4HCO3), nitrate of potash (KNO3), and ammonium bicarbonate + nitrate of potash (NH4HCO3 + KNO3). The results indicated that applying nitrate N fertilizer inhibited the reduction and dissolution of As-bearing iron minerals and promoted microbial-mediated As(III) oxidation in flooded soil, thus reducing the soil As bioavailability. The concentrations of total As and inorganic As ratio (iAs/TAs) in rice grain decreased by 32.4 % and 15.4 %, respectively. However, the application of ammonium nitrogen promoted the reductive dissolution of As-bearing iron minerals and stimulated microbial As(V) reduction in flooded soil, leading to the release of As from soil to porewater. The total As concentration and inorganic As uptake ratio in rice grain increased by 20.1 % and 6.2 %, respectively, when urea was applied, and by 29.6 % and 10.5 %, respectively, when ammonium bicarbonate was applied. However, the simultaneous application of NH4+ and NO3- had no significant effect on As concentration in rice grain and its transformation in paddy soils. Ammonium nitrogen enhanced the organic As concentration in rice grain because the increased As(III) promoted As methylation in soil. In contrast, nitrate decreased the organic As uptake by rice grain because the decreased As(III) diminished As methylation in soil. The results provide reasonable N fertilization strategies for regulating the As biogeochemical process and reducing the risk of As contamination in rice.

Effects of orthoptic therapy in children with intermittent exotropia after surgery: study protocol for a randomized controlled trial.

BACKGROUND: Intermittent exotropia (IXT) is the most common type of exotropia in China. Surgery is usually required to align the eye deviation to maintain or obtain better binocular visual function. However, there is a high rate of exodrift or recurrence in surgically treated patients. Orthoptic therapy is sometimes recommended for IXT patients after surgery. However, there is a lack of high-quality randomized controlled trials to prove that orthoptic therapy could be an effective supplement to surgical treatment for IXT patients. The main purpose of this study is to test the clinical effectiveness of orthoptic therapy in long-term stabilization of postoperative IXT patient. This report describes the design and methodology of the Intermittent Exotropia Postoperative Treatment Clinical Trial, which is the first large-sample, blank-controlled, randomized clinical trial. METHODS: A total of 136 IXT patients (aged 7 to 17 years) will be enrolled and assigned to the orthoptic therapy group or blank control group according to a simple randomization scheme. Patients in the orthoptic therapy group will receive at least 2 months of orthoptic therapy, such as anti-suppression, vergence, and accommodation training. Patients in the blank control group will receive only refractive correction. All enrolled patients will need regular follow-up observation until 24 months after surgery. The primary outcome will be the proportion of participants meeting suboptimal surgical outcomes in this 24-month follow-up, which is defined as (1) exodeviation of 10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT) or (2) loss of 2 or more octaves of stereoacuity from baseline, at any masked follow-up visit examination. The secondary outcomes will be the exodeviation at distance and near using the simultaneous prism and alternate cover test (PACT), magnitude of fusional convergence, stereoacuity, and accommodation. Measurements will be taken at baseline and at the 6-, 12-, 18-, and 24-month follow-ups. DISCUSSION: To the best of our knowledge, this will be the first prospective, randomized controlled study of orthoptic training in IXT patients after surgery. The aim of this work is to confirm the efficacy of orthoptic therapy in reducing the proportion of recurrence among IXT patients after surgery and improving binocular vision function. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900026891 . Registered on 25 October 2019.

Bioavailability of antimony and arsenic in a flowering cabbage-soil system: Controlling factors and interactive effect.

Soil contamination with antimony (Sb) and arsenic (As) has become a well-recognized environmental and human health issue. Consumption of vegetables, especially leafy vegetables, is one of the most important sources of Sb and As exposure in humans. Accordingly, it is necessary to understand the behaviors of Sb and As in the vegetable-soil system. Moreover, although Sb and As are often assumed to have similar biogeochemical behavior, identified differences in the controlling factors affecting mobility and bioavailability of Sb and As in soils need further investigation. In this study, 112 pairs of soil and flowering cabbage samples were collected from typical farmland protection areas and vegetable-producing regions across the Pearl River Delta (PRD), South China. The contamination levels of Sb and As in soils and harvested cabbages across the PRD were investigated. The main factors affecting the mobility and bioavailability of Sb and As in the cabbage-soil system were disentangled using a random forest model. The contamination levels of Sb in the cabbages and soils of the PRD were generally low, but the soils were moderately polluted by As. Increased concentrations of Fe oxides could decrease Sb accumulation in cabbages but increased the mobilization of As in soils to some extent. In contrast, Al oxides contributed strongly to the mobilization of Sb and the immobilization of As. Moreover, an increased sand content promoted the mobility of Sb and As, whereas increased silt and clay contents showed inhibitory effects. The interactions of As and Sb with Fe oxides decreased the mobility of Sb but moderately increased the mobility of As in soils. Overall, the behaviors of Sb and As in the cabbage-soil system under the effect of several important environmental factors showed some differences indicating that these differences should be considered in the remediation of co-contaminated soils.

New Arsenite Oxidase Gene (aioA) PCR Primers for Assessing Arsenite-Oxidizer Diversity in the Environment Using High-Throughput Sequencing.

Gene encoding the large subunit of As(III) oxidase (AioA), an important component of the microbial As(III) oxidation system, is a widely used biomarker to characterize As(III)-oxidizing communities in the environment. However, many studies were restricted to a few sequences generated by clone libraries and Sanger sequencing, which may have underestimated the diversity of As(III)-oxidizers in natural environments. In this study, we designed a primer pair, 1109F (5'-ATC TGG GGB AAY RAC AAY TA-3') and 1548R (5'-TTC ATB GAS GTS AGR TTC AT-3'), targeting gene sequence encoding for the conserved molybdopterin center of the AioA protein, yielding amplicons approximately 450 bp in size that are feasible for highly parallel amplicon sequencing. By utilizing in silico analyses and the experimental construction of clone libraries using Sanger sequencing, the specificity and resolution of 1109F/1548R are approximated with two other previously published and commonly used primers, i.e., M1-2F/M3-2R and deg1F/deg1R. With the use of the 1109F/1548R primer pair, the taxonomic composition of the aioA genes was similar both according to the Sanger and next-generation sequencing (NGS) platforms. Furthermore, high-throughput amplicon sequencing using the primer pair, 1109F/1548R, successfully identified the well-known As(III)-oxidizers in paddy soils and sediments, and they also revealed the differences in the community structure and composition of As(III)-oxidizers in above two biotopes. The random forest analysis showed that the dissolved As(III) had the highest relative influence on the Chao1 index of the aioA genes. These observations demonstrate that the newly designed PCR primers enhanced the ability to detect the diversity of aioA-encoding microorganisms in environments using highly parallel short amplicon sequencing.

Effect of the base-out recovery point as the surgical target for acute acquired comitant esotropia.

PURPOSE: To evaluate the treatment efficacy of the preoperative base-out recovery point as the surgical target angle for acute acquired comitant esotropia. METHODS: Prospective study. Twenty-two patients with acute acquired comitant esotropia (AACE) underwent strabismus surgery based on the target angle of the preoperative base-out recovery point. The postoperative deviation, positive fusional vergence, and negative fusional vergence were evaluated and compared with those of 23 normal individuals. RESULTS: The mean follow-up period was 18.68 ± 19.48 months. At the last follow-up, 19 (86.4%) of 22 subjects had orthophoria, whereas 3 (13.6%) had minimal esophoria. The postoperative angle of deviation was significantly smaller than the preoperative angle of deviation at near (P < 0.001) and distance (P < 0.001). Postoperative sensory fusion was significantly better than preoperative fusion at near (P < 0.001) and distance (P < 0.001). The postoperative stereoacuity improved significantly after the surgery at near (P < 0.001) and distance (P < 0.001). Compared with the controls, the convergence and divergence amplitudes in the AACE patients were similar at distance (P > 0.05) but were still narrower at near (P < 0.001). CONCLUSION: Good alignment and binocular balance were obtained with the surgical target angle of the base-out recovery point in AACE.

Genotype-Phenotype Analysis and Mutation Spectrum in a Cohort of Chinese Patients With Congenital Nystagmus.

Purpose: Congenital nystagmus (CN) is a genetically and clinically heterogeneous ocular disorder that manifests as involuntary, periodic oscillations of the eyes. To date, only FRMD7 and GPR143 have been reported to be responsible for causing CN. Here, we aimed to identify the disease-causing mutations and describe the clinical features in the affected members in our study. Methods: All the subjects underwent a detailed ophthalmic examination. Direct sequencing of all coding exons and splice site regions in FRMD7 and GPR143 and a mutation assessment were performed in each patient. Results: We found 14 mutations in 14/37 (37.8%) probands, including nine mutations in the FRMD7 gene and five mutations in the GPR143 gene, seven of which are novel, including c.284G>A(R95K), c.964C>T(P322S), c.284+10T>G, c.901T>C (Y301H), and c.2014_2023delTCACCCATGG(S672Pfs*12) in FRMD7, and c.250+1G>C, and c.485G>A (W162*) in GPR143. The mutation detection rate was 87.5% (7/8) of familial vs. 24.1% (7/29) of sporadic cases. Ten mutations in 24 (41.7%) non-syndromic subjects and 4 mutations in 13(30.8%) syndromic subjects were detected. A total of 77.8% (7/9) of mutations in FRMD7 were concentrated within the FERM and FA domains, while all mutations in GPR143 were located in exons 1, 2, 4 and 6. We observed that visual acuity tended to be worse in the GPR143 group than in the FRMD7 group, and no obvious difference in other clinical manifestations was found through comparisons in different groups of patients. Conclusions: This study identified 14 mutations (seven novel and seven known) in eight familial and 29 sporadic patients with congenital nystagmus, expanding the mutational spectrum and validating FRMD7 and GPR143 as mutation hotspots. These findings also revealed a significant difference in the screening rate between different groups of participants, providing new insights for the strategy of genetic screening and early clinical diagnosis of CN.

Development of a new framework to estimate the environmental risk of heavy metal(loid)s focusing on the spatial heterogeneity of the industrial layout.

Industrialization and urbanization have increased the risk of heavy metal(loid)s coming from a wide range of pathways and processes. Regional environmental risk assessment mainly focuses on the regional functional layout, industrial orientation, and enterprise location. These aspects may generate immense environmental risks and hazards. However, many gaps in regional environmental risk assessment remain, particularly concerning the spatial heterogeneity of environmental processes and mechanisms affected by the industrial layout. Most of the risk estimation often neglected the risk factor interaction. Here, we developed a framework to estimate the environmental risk of heavy metal(loid)s focusing on the spatial heterogeneity of the industrial layout. This framework was operationalized by performing an integrated risk detection of heavy metal(loid)s, spatial heterogeneity identification of the industrial layout, the power of risk factors and factor interaction examination, risk factor condition quantification and key risk source apportionment. Shaoguan city, one of six trial zones for China's pollution prevention and control of heavy metal(loid)s, was taken as a case study. Among all of the natural and socioeconomic factors, the running time of the industry was the most important risk factor of the Cd, As and Pb in soil and rice in all subregions. These subregions were divided based on the spatial heterogeneity of the industrial layout. The threshold of the running time of the industry for soil Cd was 11.97 years. The power of other dominant risk factors was different in different subregions, and the joint risk of the dominant risk factors was larger than the single risk of the running time of the industry. Our results suggest that the environmental risk of heavy metal(loid)s in Shaoguan could be mitigated by adjusting the industrial structure and controlling the running time of enterprises. Our study also indicates that estimating the regional environmental risk of heavy metal(loid)s focusing on the spatial heterogeneity of the industrial layout can help define specific strategies to achieve environmentally friendly industrial development.

Multiple effects of nitrate amendment on the transport, transformation and bioavailability of antimony in a paddy soil-rice plant system.

Nitrate (NO3-) is known to be actively involved in the processes of mineralization and heavy metal transformation; however, it is unclear whether and how it affects the bioavailability of antimony (Sb) in paddy soils and subsequent Sb accumulation in rice. Here, the effects of NO3- on Sb transformation in soil-rice system were investigated with pot experiments over the entire growth period. Results demonstrated that NO3- reduced Sb accumulation in brown rice by 15.6% compared to that in the control. After amendment with NO3-, the Sb content in rice plants increased initially and then gradually decreased (in roots by 46.1%). During the first 15 days, the soil pH increased, the oxidation of Sb(III) and sulfides was promoted, but the reduction of iron oxide minerals was inhibited, resulting in the release of adsorbed and organic-bound Sb from soil. The microbial arsenite-oxidizing marker gene aoxB played an important role in Sb(III) oxidation. From days 15 to 45, after NO3- was partially consumed, the soil pH decreased, and the reductive dissolution of Fe(III)-bearing minerals was enhanced; consequently, iron oxide-bound Sb was transformed into adsorbed and dissolved Sb species. After day 45, NO3- was completely reduced, Sb(V) was evidently reduced to Sb(III), and green rust was generated gradually. Thus, the available Sb decreased due to its enhanced affinity for iron oxides. Moreover, NO3- inhibited the reductive dissolution of iron minerals, which ultimately caused low Sb availability. Therefore, NO3- can chemically and biologically reduce the Sb availability in paddy soils and alleviate Sb accumulation in rice. This study provides a potential strategy for decreasing Sb accumulation in rice in the Sb-contaminated sites.

Effect of plum-blossom needling versus tropicamide eye drops on adolescent myopia: protocol for a randomized crossover trial.

OBJECTIVE: Myopia is the most common eye problem and affects an estimated 28.3% of the global population. Its incidence is increasing annually. Myopia treatment is limited to correcting visual acuity. Acupuncture is one of the main therapies in traditional Chinese medicine and includes plum-blossom needling, which has been widely used for both the prevention and treatment of adolescent myopia. We hypothesized that plum-blossom needling would be effective in treating myopia compared with a tropicamide eye drops control. METHODS: This is a crossover randomized controlled trial involving adolescents with myopia. Participants will be randomized 1∶1 to plum-blossom needle or tropicamide eye drops arms. Subjects in each arm will be treated for 20 d, followed by a 1-month washout period and treatment change for another 20 d. The primary outcome is uncorrected distance and cycloplegic refractive errors. The secondary outcomes comprise corneal curvature, lens thickness, axial length, ciliary body thickness, accommodation amplitude, the NRA/PRA (negative/positive relative accommodation), flexible adjustment, and near point of convergence. The outcome measures will be assessed at baseline, after the first treatment course (the first month), at the end of the washout period (the second month), after the second treatment course (the third month), and at follow-up (the sixth month). DISCUSSION: The results of the trial will help to provide evidence for the efficacy of plum-blossom needling for myopia in China.

Behaviors of heavy metal(loid)s in a cocontaminated alkaline paddy soil throughout the growth period of rice.

A pot experiment was conducted to investigate uptake of cadmium (Cd), arsenic (As) and antimony (Sb) by rice from a lime-treated paddy soil contaminated with the three pollutants. The results showed that the content of Cd in the total rice plants decreased as the plant grew, whereas the As and Sb contents increased steadily. The concentration of As in the pore water showed steady increase throughout the growth period, likely due to the reductive dissolution of iron (Fe)-bearing minerals and the reduction of As(V). In contrast, the concentrations of Cd and Sb in the pore water increased initially, likely attributable to the reductive dissolution of Fe-bearing minerals, and then decreased likely due to their adsorptions onto carbonate and Fe sulfides, the reduction of Sb(V), and the formation of CdS. A random forest model was used to quantitatively evaluate the relative contributions of environmental factors to the accumulation of Cd, As, and Sb in the rice plants. The results suggest that sulfides produced through sulfate reduction and the formation of Cd forms associated with sulfur (S) might significantly affected the Cd content in the rice plants. In addition, the dissolved Fe species, the oxidation-reduction potential, and the abundance of the As(V)-respiring gene were major contributors to the As content in the rice plants, suggesting the important role of the reduction of Fe-bearing minerals and As(V). The results also showed that the Sb content in the rice plants was correlated with Fe species, Sb(V) reduction, and acid volatile S. The environmental behaviors of Cd, As, and Sb in the cocontaminated paddy soil exhibited significant differences. Such differences should be considered in remedy of soils contaminated with multiple heavy metals and metalloids.

Factors influencing the self-reported sense of deviation in adults with successful surgical outcomes for strabismus.

BACKGROUND: To determine whether a sense of deviation remains in adults with successful motor alignment who fulfil diplopia criteria after surgery and to examine the factors associated with this judgement. METHODS: This was a retrospective study. Adult patients defined as having a successful outcome based on more than 1 year of post-operative follow-up visits were included in the study. The sense of deviation was determined at the last visit. Pre- and post-operative deviation and characteristics including age, gender, education level, occupation, diagnosis, size of deviation, extraocular movement (EOM), binocular function, and health-related quality of life (HRQOL) were recorded. RESULTS: In total, 22 (24%) of the 91 adults with successful surgical outcomes reported a sense of deviation. No significant differences were noted between subjects with and without a sense of deviation regarding patient demographics, pre- and post-operative deviation, changes in deviation, sensory fusion or EOM. Subjects with a sense of deviation had an increased prevalence of and larger post-operative vertical deviation, poorer stereo function, and lower HRQOL scores than those with no sense of deviation. The presence of post-operative vertical deviation was associated with a sense of deviation. CONCLUSIONS: Approximately one-fourth (24%) of adults defined as having successful surgical outcomes who still had a sense of deviation exhibited worse stereo function, higher vertical deviation size and lower HRQOL scores. The presence of 3 to 5 prism dioptres(pd) of vertical deviation would be the main factor associated with a sense of deviation post-operatively.

Health-related quality of life correlated with the clinical severity of intermittent exotropia in children.

OBJECT: To evaluate whether the results of the health-related quality of life (HRQOL) is associated with the various clinical aspects of intermittent exotropia in children. METHODS: The HRQOL of children and their parents was evaluated prospectively using the Intermittent Exotropia Questionnaire (IXTQ). The deviation angle, stereo function, sensory fusion, and strabismus control were measured. RESULTS: Two hundred and sixty six children with intermittent exotropia (aged 5-17 years) were included in the study. Child HRQOL was significantly correlated with clinical severity; lower IXTQ scores were associated with a larger deviation (p < 0.001 both for distance and near) and poorer Newcastle control scores (p < 0.001). Proxy child HRQOL was significantly correlated with the deviation (p < 0.001), Newcastle control scores (p < 0.001) and stereo function (p < 0.05). Parent HRQOL was associated with their child's deviation (p < 0.01) and stereo function (p < 0.005). Multiple linear regression analysis suggested that the deviation angle at distance and the Newcastle control score at home were associated with the child's HRQOL. CONCLUSION: Both the child and their parents' HRQOL showed a trend toward correlating with clinical severity. Large deviation, poor control, and poor stereo function were significantly associated with lower IXTQ scores. The deviation angle at distance and exotropia control at home were associated with the child's HRQOL.

Interactive effects of multiple heavy metal(loid)s on their bioavailability in cocontaminated paddy soils in a large region.

Heavy metal(loid) pollution in large regions is often highly complex due to the coexistence and interactions of metal(loid)s and complex soil environments. However, the interaction effects of heavy metal(loid)s on their bioavailability in large regions remain obscure. Here, we identified the interaction effects of Pb, Cd and As on their bioavailability in cocontaminated paddy soils of Shaoguan City, China. The results showed that pH (12.40%) was the most important impact factor among the key soil properties of the pH, CEC, and SOM for the bioconcentration factor (BCF) of Cd. As the soil Pb content decreased and the soil Cd content increased, the interaction of soil Pb and Cd increased the BCF of Pb. As the soil Pb content increased and the soil Cd content decreased, the interaction of soil Pb and Cd increased the BCF of Cd. The synergistic interaction of Pb and Cd in soil promoted the accumulation of both Pb and Cd in rice under certain soil conditions. Specifically, when the average pH and CEC were below 6.19 ± 0.82 and above 7.23 ± 2.55 cmol (+)/kg, respectively, the average BCF of Cd varied from 0.70 ± 0.80 to 1.47 ± 0.62 due to the interactive effect of soil Cd and Pb on the BCF of Cd. When the average pH was above 6.19 ± 0.82 and the average SOM was below and above 27.12 ± 20.34 mg/kg, respectively, the corresponding average BCF of Cd varied from 0.70 ± 0.63 to 0.10 ± 0.26. As the average soil Cd and As contents increased, the interactive effect of soil As and Cd on the average BCF of As decreased. The negative interaction of As and Cd in soil mitigated As accumulation in rice at certain soil Cd and As contents. Our results suggest that to achieve the large-scale control of heavy metal(loid) pollution, the interactions among multiple metal(loid)s and soil properties should be considered.

Enhanced immobilization of arsenic and cadmium in a paddy soil by combined applications of woody peat and Fe(NO3)3: Possible mechanisms and environmental implications.

Organic matter (OM) plays an important role in the mobility of heavy metal(loid)s. Peat containing abundant OM can be used as an organic fertilizer improving physical and chemical properties of soil. Previous studies indicated that the immobilization of heavy metal(loid)s by peat is affected by the presence of metal oxides and/or hydroxides and that Fe-enriched peat is very effective in immobilizing metal(loid)s. Accordingly, we hypothesize that simultaneous application of peat and Fe-containing compounds may pronouncedly immobilize heavy metal(loid)s. In this study, the effects of the combined applications of woody peat and Fe(NO3)3 on As and Cd mobilities and accumulations in rice during the whole growth period were investigated by a pot experiment. The combined applications of woody peat and Fe(NO3)3 significantly decreased As(III) and Cd in porewater due to pH increases induced by applications of Fe(NO3)3, and these decreases were enhanced with increasing Fe(NO3)3. In addition, simultaneous application of peat and Fe(NO3)3 significantly decreased mobile portions of As and Cd but significantly increased their immobile portions. Increasing Fe(NO3)3 increased the amount of As immobilized by poorly crystalline Fe oxides. The formation of Fe plaques and production of poorly crystalline Fe oxides were enhanced by Fe(NO3)3 addition, which also contributed to the immobilization of As and Cd in soil. Overall, the combined applications of woody peat and Fe(NO3)3 provided a strategy for simultaneously immobilizing As and Cd in soils and further alleviating their accumulations from soil to rice plants. In paddy soil, the frequent occurrence of iron redox activity due to the alternating wetting and drying cycles provided favorable conditions for interactions between Fe and OM, and this process and its associated metal(loid) immobilization may be more important than we thought and need further study.

A causation-based method developed for an integrated risk assessment of heavy metals in soil.

A comprehensive and fact-based risk assessment of heavy metals in soils is paramount for defining strategies for environmental management. However, the risk assessment approaches of heavy metals in soils are often incomplete, in particular, causation-based pollution source apportionment is absent at present. Here, we developed a causation-based method framework of an integrated risk assessment of soil heavy metals. This method framework involves risk identification, causation-based source apportionment and an environmental sensitivity assessment. Dongtang Township in Guangdong Province, China was used as a case study. We found that air Cd, the background value and metallurgical industries (Danxia and Fankou plants) were identified as the major causes of soil Cd, and air and soil Cd as well as water Cd interacted causally. Danxia and Fankou plants, the mining area and background value were the major causes of soil Pb. The risk level and environmental sensitivity of the Danxia and Fankou plants were assessed. This is the first study to establish a causation-based method framework of an integrated risk assessment of soil heavy metals. This framework promotes systematic integration of risk assessment of soil heavy metals and expands traditional research on pollution source apportionment from a correlation-based approach to crucial insights into causation.