From real world data to real world evidence to improve outcomes in neuro-ophthalmology.

Real-world data (RWD) can be defined as all data generated during routine clinical care. This includes electronic health records, disease-specific registries, imaging databanks, and data linkage to administrative databases. In the field of neuro-ophthalmology, the intersection of RWD and clinical practice offers unprecedented opportunities to understand and treat rare diseases. However, translating RWD into real-world evidence (RWE) poses several challenges, including data quality, legal and ethical considerations, and sustainability of data sources. This review explores existing RWD sources in neuro-ophthalmology, such as patient registries and electronic health records, and discusses the challenges of data collection and standardisation. We focus on research questions that need to be answered in neuro-ophthalmology and provide an update on RWE generated from various RWD sources. We review and propose solutions to some of the key barriers that can limit translation of a collection of data into impactful clinical evidence. Careful data selection, management, analysis, and interpretation are critical to generate meaningful conclusions.

Research progress on the mechanism of action of Salvia miltiorrhiza and its components in the treatment of endometrial carcinoma.

The incidence and mortality of endometrial carcinoma (EC) are increasing year by year. Although the curative effect of surgery and commonly used drugs is clear, it is accompanied by obvious side effects, and safe and effective means are urgently needed to promote the curative effect and decrease the toxicity of drugs. Traditional Chinese medicine has been passed down for thousands of years in China and has proved to be advantageous in the treatment of various cancers and the auxiliary enhancement and reduction of toxicity. This paper reviewed the role and internal mechanism of Salvia miltiorrhiza in preventing and treating endometrial carcinoma by referring to relevant literature and works, so as to more comprehensively understand and grasp the research status, effective components, curative effect and effective mechanism of S. miltiorrhiza in preventing and treating endometrial carcinoma, and provide ideas and basis for clinical use and basic research.

EQ-5D-5L health utility scores in Australian adults with inherited retinal diseases: A cross-sectional survey.

PURPOSE: Economic evaluations of interventions for ocular disease require utility scores that accurately represent quality of life in the target population. This study aimed to describe the distribution of EQ-5D-5L utility values among Australian adults with symptomatic inherited retinal diseases (IRDs) and to assess the relationship between these scores and vision-related quality of life. METHODS: A survey was administered predominantly online in 2021. Participants completed the EQ-5D-5L general health utility instrument, the EQ vertical visual analogue scale (EQ-VAS) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Self-reported IRD diagnoses were classified as being associated with central or widespread retinal involvement. RESULTS: Responses from 647 participants aged 18-93 years were included, 50.1% were men and 77.6% had an IRD associated with widespread retinal involvement. The majority reported no problems with self-care and no pain/discomfort but did report anxiety/depression and problems with work, study, housework, or family/leisure activities. Most people with widespread involvement reported problems with mobility. Median EQ-5D-5L utility was 0.88 and 0.91 among people with widespread and central involvement, respectively (age and sex-adjusted p = 0.029); and median EQ-VAS was 75 and 80, respectively (adjusted p = 0.003). A moderate curvilinear correlation was observed between EQ-5D-5L and NEI-VFQ-25 composite score (Spearman's ρ 0.69), but not all people with poor vision-related quality of life had low EQ-5D-5L utility values. CONCLUSIONS: EQ-5D-5L health utility values are correlated with vision-related quality of life among adults with IRDs. However, the EQ-5D-5L may not be sensitive to the full impact of vision impairment on quality of life.

Macular and peripapillary Choroidal Vascularity Index in children with different refractive status.

OBJECTIVES: To characterize choroidal vascular changes in children with different refractive status. METHODS: A study including 5864 children aged 6-9 years was performed to investigate the choroidal vascular index (CVI) in myopic, emmetropic and hyperopic eyes. Each participant had a comprehensive ocular examination with cycloplegic autorefraction performed, axial length (AL) measured and Swept Source-Optical Coherence Tomography (SS-OCT) scans acquired. Choroidal thickness (ChT) was measured by built-in software, and CVI was calculated using a previously validated self-developed algorithm. RESULTS: The mean ChT and CVI were 275.88 ± 53.34 µm and 34.91 ± 3.83 in the macula region, and 191.96 ± 46.28 µm and 32.35 ± 4.21 in the peripapillary region. CVI was significantly lowest for myopes, followed by emmetropes and hyperopes (P < 0.001). CVI varied between different sectors separated by the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid (P < 0.001). Macular CVI decreased horizontally from nasal to temporal quadrant with lowest in center fovea, and vertically from superior to inferior quadrants. Peripapillary CVI was highest in the nasal and lowest in the inferior sector. Multiple regression showed that spherical equivalent (SE), AL, intraocular pressure (IOP), ChT, age, and gender were significantly related to CVI (P < 0.05). CONCLUSIONS: In children, the distribution of CVI in the posterior pole is not uniform. A decreased CVI was observed from hyperopia to myopia and was associated with decreased SE, elongated AL, and choroidal thinning. Further study of changes in CVI during myopia onset and progression is required to better understand the role of the choroidal vasculature in myopia development.

Normative value of hyperopia reserve and myopic shift in Chinese children and adolescents aged 3-16 years.

BACKGROUND: This research aims to generate normative values of hyperopia reserve and refractive progression as effective tools to estimate the risk of myopia. METHODS: A 1-year follow-up study was conducted among Chinese children and adolescents aged 3-16 years selected from schools and kinder gardens using cluster sampling. All participants underwent examinations including visual acuity, axial length and cycloplegic autorefraction (1% cyclopentolate). Percentiles of spherical equivalent (SE) were calculated using Lambda-Mu-Sigma (LMS) method. Age-specific refractive progression and hyperopia reserve were determined by backward calculation. RESULTS: Of 3118 participants, 1702 (54.6%) were boys with a mean baseline age of 7.30 years. The 50th percentile of SE estimated by LMS decreased from 1.04 D at 3 years to -2.04 D at 16 years in boys, while from 1.29 D to -2.81 D in girls. The 1-year refractive progression of myopes (0.81 D) was greater than that of non-myopes (0.51 D). The normative value of hyperopia reserve was 2.64 (range: 2.40 D-2.88 D) at 3 years and -0.35 (range: -0.50 to -0.17) D at 16 years, with the maximum progression of 0.35 D at the age of 6 years. CONCLUSION: Age-specific normative values of hyperopia reserve and yearly myopic shift in children and adolescents aged 3-16 years were provided, helping identify and monitor myopia and giving prevention in advance.

Barriers and facilitators of the implementation of the application of pelvic floor muscle training in patients with prostate cancer: a scoping review.

Background: Patients with prostate cancer (PCa) benefit significantly from pelvic floor exercises, but recent results indicate that these exercises have not been fully promoted in clinical settings. This scoping review aimed to identify the facilitators of and barriers to pelvic floor muscle training (PFMT) in PCa survivors. Methods: A scoping review was conducted in November 2022. Relevant studies were identified from CINAHL, Embase, PubMed, PsycINFO, and Web of Science databases from their inception to 20 November 2022. Data were analyzed and extracted by two formally trained researchers. Results: A total of 53 studies were included, most of which were randomized controlled trials. The Tailored Implementation for Chronic Diseases (TICD) model framework was used to identify the contents of seven barriers and promotion areas, as well as a series of sub-domains. The most common barriers to implementing pelvic floor muscle training (PFMT) included the following: the lack of a common scheme in guidelines and the measurement of common standardized outcomes, inadequate self-monitoring or feedback from healthcare professionals to improve PFMT compliance, poor patient compliance, and a lack of implementation equipment and financial support. Good treatment effects and easy operation were the facilitators of PFMT. Conclusion: The implementation of PFMT faces several challenges and opportunities that should be understood thoroughly before implementation. In terms of guidelines and clinical practice, more work is needed, and the possibility of PFMT implementation in various hospitals and community health centers or clinics should be considered.

Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review.

AIMS: To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. METHODS: A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report. RESULTS: A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 µs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. CONCLUSION: The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. RELEVANCE TO CLINICAL PRACTICE: Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.

A New Side-Looking Scheme for Speed Estimation and Detection of Tangential Slow-Moving Targets.

A single-beam radar system cannot adopt a side-looking installation scheme, which is completely perpendicular to the moving direction of the target in an intelligent transportation system (ITS), because of its own limitations. In this paper, a side-looking radar velocity measurement system that utilizes a new signal processing method and multi-channel radar scheme is proposed. Constant false alarm rate (CFAR) and generalized likelihood ratio test (GLRT) detectors are used to detect the data processing results in different stages in order to reduce the false alarm rate of targets. At the same time, a deconvolution-based clutter map algorithm is proposed to solve the problem of clutter interference in the test environment, and its theoretical performance is verified by simulation. Finally, 77 G commercial radar is used to test the system, and the results show that this algorithm can effectively detect and accurately estimate the speed of tangential low-speed targets under clutter interference.

Accommodative responses under various viewing conditions in surgical patients with intermittent exotropia: an institutional, retrospective study.

PURPOSE: To investigate the difference of spherical equivalent (SE) and pupil diameter in adult patients with intermittent exotropia (IXT) under various viewing conditions before and after surgery. METHODS: We retrospectively analyzed the medical records of 23 adult patients who underwent a surgery for IXT. The angle of deviation was measured by the prism and alternative cover test. Refractive error and pupil diameter were measured using the Grand Seiko WAM-5500 open-field autorefractor under binocular and monocular viewing conditions when patients stared at distance (6 m) and near (33 cm). Regression analyses were performed between accommodative load and the angle of deviation. RESULTS: Twenty-three patients (10 males, 13 females) with a mean age of 31.17±8.95 years, of whom 13 (56.5%) had the right eye as the dominant eye. The mean angle of deviation at near and at distance was 69.57±26.37 and 65.43±28.92 prism diopters respectively. There were no significant differences in accommodative response and pupil diameter between the dominant and non-dominant eyes. SE decreased when patients changed from monocular to binocular viewing, and from distant to near viewing (all P< 0.05), so as the pupil diameter (all P< 0.001). During binocular, not monocular viewing, SE was significantly greater after operation than it was before operation (P< 0.001). Accommodative load and pupillary constriction narrowed (p< 0.001) after the operation. Linear regression analysis showed a correlation between the angle of deviation at distance and accommodative load at distance (r2=0.278, p=0.010) and at near (r2=0.332, p=0.005). CONCLUSION: In order to maintain ocular alignment, patients with IXT suffer a large accommodative load, which is related to the angle of deviation. Surgery helps eliminating extra accommodation.

Inhibiting TLR9 Signaling Stimulates Apoptosis and Cell Cycle Arrest, and Alleviates Angiogenic Property in Human Cervical Cancer Cells.

AIMS: The aim of the study was to assess the effect of blocking TLR9 signaling on the proliferation of cervical cancer cells and its angiogenic property. BACKGROUND: Toll-Like Receptors (TLRs) have been implicated for their crucial role in not only cervical cancer but also in other malignancies. TLR9 is expressed on an array of cells such as macrophages, dendritic cells, melanocytes, and keratinocytes and is reported to modulate oncogenesis along with tumorigenesis by augmenting NF-κB mediated inflammation within the tumor environment. TLR9 has also been reported to positively regulate oncogenesis within the cervix and as a marker to evaluate malignant remodeling of cervical squamous cells. Therefore, this study was designed to explore the functional relevance of blocking the TLR9signaling pathway in cervical cancer cells. OBJECTIVE: The objective of the current study was to investigate the effect of human TLR9 antagonist, ODN INH-18, on apoptosis and cell cycle regulation, and angiogenic property of human cervical cancer Caski cells. METHODS: MTT assay was performed to measure cell viability and flow cytometry analysis was performed to assess cell cycle arrest. Quantitative Real-Time PCR (qRT-PCR) analysis was performed to measure fold change in the gene expression of various markers of apoptosis, cell cycle regulation, and angiogenesis. RESULTS: The qRT-PCR results showed a higher expression level of TLR9 mRNA in Caski cervical cancer cells as compared to normal cervical keratinocytes. The apoptotic, angiogenic, and cell cycle regulatory factors were also deregulated in Caski cells in comparison to normal keratinocytes. The MTT assay demonstrated that treatment of TLR9 antagonist, ODN INH18, significantly reduced the proliferation of Caski cells in a dose-dependent manner. Treatment of ODN INH18 led to substantial cell cycle arrest in Caski cells at G0/G1 phase. Moreover, the qRT-PCR results demonstrated that ODN INH18 treatment led to suppressed mRNA expression of Bcl-2 and enhanced expression of Bax, signifying the induction of apoptosis in Caski cells. Moreover, the expression of cyclin D1, Cdk4, and Cdc25A was found to be reduced whereas expression of p27 was increased in ODN INH18-treated Caski cells; indicating G0/G1 phase arrest. Interestingly, expression of VEGF and VCAM-1 was found to be significantly inhibited in ODN INH18-treated Caski cells, substantiating alleviation of angiogenic property of cervical cancer cells. CONCLUSION: The results of our study suggest that inhibiting TLR9 signaling might be an interesting therapeutic intervention for the treatment of cervical cancer.

Influence of physical activity patterns on academic performance in children and adolescents / 中国学校卫生

Abstract@#Physical activity promotes the physical and mental health of children and adolescents, and a growing body of research has demonstrated the positive effects of physical exercise, including better academic performance. This review presents a retrospective analysis of the existing literature in order to explore the relationship between physical activity patterns and academic performance in children and adolescents. This study analyzes the impact of differences in the duration, frequency, intensity, and type of physical activity on the academic performance of children and adolescents, which provides a basis for improving the quality and effect of such physical activities. High-quality evidence supports the view that long-term, high-frequency, aerobic physical activities of moderate-to-vigorous intensity have a positive impact on children and adolescents’ academic performance. This study provides a reference to help families, schools, and society to scientifically and rationally promote physical activity among children and adolescents.

Characterized cantharidin distribution and related gene expression patterns in tissues of blister beetles, Epicauta chinensis.

Cantharidin (CTD), a terpenoid defensive toxin mainly produced by blister beetles, is widely known by its toxicity to both cancer cells and pests. However, little information is known about its biosynthesis in blister beetles. In this study, first we determined the CTD content in various tissues of adult blister beetles on different days after mating, and then detected the temporal and spatial expression patterns of genes related to CTD biosynthesis in Epicauta chinensis. Results revealed that the accessory gland is the source of the highest CTD production. The second highest level was in the fat body in male blister beetles after mating. In females, the highest CTD content was in the reproductive system except the ovary after mating. As revealed by messenger RNA expression level analysis, the highest levels of 3-hydroxy-3-methylglutary-CoA reductase (HMGR) and juvenile hormone epoxide hydrolase (JHEH) transcripts of E. chinensis were observed in the fat body in males after mating. However, the highest transcript level of EcHMGR was in the ovary and EcJHEH was maintained at a nearly similar level in females. The transcript level of methyl-farnesoate epoxide was significantly higher in the head and that of CYP4BM1 in the midgut in both male and female E. chinensis. We speculate that the fat body may play a more important role than other tissues on the CTD biosynthesis in male E. chinensis after mating. There may be multiple tissues involved in the process of CTD biosynthesis. These four genes probably play regulatory roles in different tissues in males.

High-coordinate CoII and FeII compounds constructed from an asymmetric tetradentate ligand show slow magnetic relaxation behavior.

Using an asymmetric tetradentate ligand N-((6-(1H-pyrazol-1-yl)pyridin-2-yl)methylene)benzohydrazide (pypzbeyz), two high-coordinate 3d transition metal compounds [CoII(pypzbeyz)(NO3)2] (1) and [FeII(pypzbeyz)2](BF4)2(CH3CN) (2) have been synthesized and characterized by structural and magnetic measurements. X-ray crystallographic analyses revealed that compound 1 is seven-coordinate with a distorted pentagonal bipyramidal geometry (pseudo-D5h) and compound 2 is eight-coordinate with a triangular dodecahedral geometry (pseudo-D2d). Direct current (dc) magnetic susceptibilities revealed that compound 1 shows easy-plane magnetic anisotropy (D = +29.9 cm-1, E = 0.31 cm-1) and 2 shows easy-axis magnetic anisotropy (D = -6.6 cm-1, E = 0.02 cm-1). Alternating current (ac) magnetic measurements indicate that both compounds exhibit field-induced slow magnetic relaxation behavior. Furthermore, ab initio calculations also demonstrate that compound 1 presents a strong easy-plane magnetic anisotropy and 2 presents an easy-axis magnetic anisotropy, which are further identified by the calculated orientations of the local magnetic axes. These results demonstrate an effective way to achieve the targeted synthesis of high-coordinate 3d SIMs.