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BACKGROUND Ophthalmoscopy and its interpretation are complex. We aimed to compare the diagnostic accuracy of smartphone fundoscopy with traditional direct ophthalmoscopy for optic disc interpretation, with e-learning support. METHODS We conducted a randomised, crossover study of 102 medical students. Students were offered e-learning for optic disc interpretation. A fundoscopy objective structured clinical examination was conducted after an introductory lecture and 10-min practical training session on smartphone fundoscopy and traditional ophthalmoscopy. Participants examined patients and simulator slides with a randomised crossover between smartphone [D-eye (Padova, Italy) or iExaminer (Welch Allyn, Macquarie Park, Australia)] and traditional ophthalmoscopy (Welch Allyn). Optic discs were graded independently by three masked ophthalmologists. The primary outcome was the ability to interpret an optic disc as normal or abnormal. Secondary outcomes included other optic disc aspects; student preferences; and e-learning performance. RESULTS Students' agreement with the gold standard for an abnormal or normal disc was significantly greater using a smartphone (74.4%) than with direct ophthalmoscopy (68.1%, p = 0.032). More students preferred smartphone (74%) over direct ophthalmoscopy (26%, p

A method for lead (Pb) detection in soil is presented. Pb is a dangerous environmental pollutant that is present in soils, posing a health risk to millions of people worldwide, and regular monitoring of Pb contamination in soils is essential to public health. Many sensitive methods for detection of heavy metals in solid matrices exist, but they cannot be performed on-site because they are costly (>$30 per sample), require trained personnel, and many classical sample preparation methods are not safe to bring into the field. We describe an alternative process, combining a safer sample preparation method with electrochemical analysis. The process requires minimal training, making it an attractive overall method for regular environmental screening of Pb in soils. Extract obtained from the soil is pH adjusted and analyzed using a stencil-printed carbon electrode and square wave anodic stripping voltammetry. In this work, a study of 15 neighborhood soils examining the concentration of Pb present post-extraction was performed to demonstrate the method. The limit of detection for the electrochemical analysis was calculated to be 16 ppb—well below the United States Environmental Protection Agency's action limit for Pb in soils (400 mg kg−1 or 4000 ppb)—and third party inductively coupled plasma-optical emission spectroscopy analysis validated the results obtained in this study to within ±17% on average.

BACKGROUND Weight loss is important in the management of idiopathic intracranial hypertension (IIH); however, extremely caloric restrictive diets have been used in published studies, which may not be practical for all patients. We aim to review the weight loss outcomes of IIH patients and weight loss methods used by patients who achieve clinical remission (CR) in a standard clinical setting. METHODS The medical records of IIH patients were retrospectively reviewed. Measures evaluated included: reported symptoms, visual acuity, retinal nerve fiber layer analysis, automated visual fields, optic disc appearance, and cessation of medications. Patients were divided into different outcome groups and weight changes were compared. Patients who achieved CR were contacted to assess weight loss methods used. RESULTS Of the 39 patients included in the analysis, 28 patients (71.8%) achieved CR with concomitant weight loss, 6 patients (15.4%) improved clinically with concomitant weight loss but did not achieve CR. Among the patients with CR, 10 patients (35.7%) were successfully weaned off their medications completely, whereas another 10 patients (35.7%) are in the process of this. Median weight loss from baseline to lowest weight for this group was 10.5 kg (11.5%) achieved using self-directed methods. CONCLUSION This study demonstrated that a large proportion of IIH patients were able to achieve CR or improvement with self-directed weight loss regimens, reinforcing the evidence and the practicality of weight loss in the management of IIH in the clinical setting.

Whole genome sequencing (WGS) is championed by the UK National Health Service (NHS) to identify genetic variants that cause particular diseases. The full potential of WGS has yet to be realised as early data analytic steps prioritise protein-coding genes, and effectively ignore the less well annotated non-coding genome which is rich in transcribed and critical regulatory regions. To address, we developed a filter, which we call GROFFFY, and validated in WGS data from hereditary haemorrhagic telangiectasia patients within the 100,000 Genomes Project. Before filter application, the mean number of DNA variants compared to human reference sequence GRCh38 was 4,867,167 (range 4,786,039-5,070,340), and one-third lay within intergenic areas. GROFFFY removed a mean of 2,812,015 variants per DNA. In combination with allele frequency and other filters, GROFFFY enabled a 99.56% reduction in variant number. The proportion of intergenic variants was maintained, and no pathogenic variants in disease genes were lost. We conclude that the filter applied to NHS diagnostic samples in the 100,000 Genomes pipeline offers an efficient method to prioritise intergenic, intronic and coding gDNA variants. Reducing the overwhelming number of variants while retaining functional genome variation of importance to patients, enhances the near-term value of WGS in clinical diagnostics.

Sanya Bay, a tropical open coral-reef bay in the northern South China Sea, is undergoing great changes in environmental conditions due to the rapid increase in human activities. This study assessed spatial and temporal variation in copepod species composition, abundance, and distribution in relation to environmental variables in Sanya Bay. A total of 63 copepod species were identified. The annual average abundance of copepods was 4707.1 ± 2763.8 ind m – 3 , with the highest densities observed in winter and the lowest densities observed in summer. The number of copepod species increased from nearshore to offshore waters of the bay, whereas their abundance decreased seaward, with highest values being recorded in nearshore waters. Approximately 90% of copepod recorded in this study belonged to 11 dominant species.Parvocalanus crassirostriswas the most common and abundant species in Sanya Bay. Abundances of total copepods and P. crassirostris were negatively correlated with temperature and positively correlated with chlorophyll a concentration, but no significant correlation between them was found in spring, summer or fall. High abundances of copepods were mainly concentrated near the mouth of the Sanya River. The seasonal and regional patterns of copepod variation in Sanya Bay were characterized by low diversity and high abundance in winter, and by highest abundance in the nearshore waters during the four sampling periods. Copepod abundance distribution in winter was enhanced by low temperature and high chlorophyll a concentration, and was driven by the dominant species P. crassirostris.

The seasonal variation and spatial distribution of chaetognaths were studied based on samples collected from July to August 2006 (summer), December 2006 to January 2007 (winter), and in April 2007 (spring) on the north-west continental shelf of the South China Sea. A total of 19 species of chaetognaths were identified. The average chaetognath abundances (mean ±SD) were 54.0 ± 44.5, 36.8 ±16.7 and 48.9 ± 95.5 ind. m−3 in summer, winter and spring, respectively. Flaccisagitta enflata and Serratosagitta pacifica were the dominant species during the whole sampling period, and F. enflata determined the spatial distribution of total chaetognath abundance. According to the topography and hydrological conditions, the survey area was divided into three sub-regions: inshore waters of the western Guangdong (Region I), inshore waters to the east of Hainan Island (Region II) and offshore waters from the western Guangdong to Hainan Island (Region III). The community structure and abundance distribution of chaetognaths varied significantly between the three sub-regions. The species richness was significantly different among the three sub-regions, with the lowest in Region I and the highest in Region III. The species richness was correlated positively with temperature and salinity. The abundance of chaetognaths was significantly higher in Region I than in both Regions II and III in summer and spring. The increasing food availability caused by the cold eddy, coastal upwelling and the western Guangdong coastal current was able support a greater abundance of chaetognaths during warm seasons on the north-west continental shelf of the South China Sea.

Liu Weiran,1,* Zhang Lei,2,* Stephanie Mu-Lian Woo,3,* Tang Anliu,4,* Xie Shumin,4,* Zhang Jing,5,* Zhang Kai,6,* Zhang Zhen7 1Department of Anesthesia, 2Department of Thoracic Surgery, Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China; 3Harvard University, Cambridge, MA, USA; 4Xiangya Medical School of Central South University, Changsha, People's Republic of China; 5Tianjin Medical University, Tianjin, People's Republic of China; 6Department of Cerebral Surgery, Tumor Hospital Xiangya School of Medicine, Central South University, Changsha, People's Republic of China; 7Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China *These authors contributed equally to this work Background: This study aims to analyze the current status of postoperative pain management in the People's Republic of China's provincial-level hospitals, and the existing knowledge and opinions held by patients regarding these methods. Methods: The 128 participants in this study were urology and hepatobiliary patients from three provincial-level hospitals in Hunan. The questionnaire assessing postoperative pain was designed using the typical pain assessment scales and pain management guidelines as references. Results: 82.8% of study participants claimed that their postoperative pain was relieved within 3 days of their operations. However, while 91.4% of surveyed patients experienced moderate to severe pain, 51.6% received no treatment for their postoperative pain, and 14.9% complained that medical personnel failed to manage their pain. 20.2% were unsatisfied with their pain management, indicating that treatment did not meet their expectations. Furthermore, participants demonstrated a great misunderstanding of pain and analgesics, as 72.6% of patients were unfamiliar with morphine, 51.6% of patients believed only certain types of pain required management, and 18.5% refused to use morphine. Conclusion: In most Chinese provincial-level hospitals, current postoperative pain management methods are able to alleviate the pain experienced by the majority of patients, though pain assessment and therapy procedures are still not standardized. Furthermore, most patients lack a proper understanding of postoperative pain and analgesics. Therefore, pain management education for doctors and patients and their relatives should be implemented in order to improve the quality of postoperative pain management. Keywords: postoperative pain, pain assessment, pain management, pain recognition, pain education

Differences in siphonophore communities between summer and winter in the northern South China Sea and the influence of environmental conditions on their variations were studied. Our results suggested that local coastal upwelling and surface ocean currents driven by the southwest monsoon enhanced the species number and abundance of siphonophores in summer, while the northeast monsoon forced the cold coastal current into the study area, resulting in low species richness and abundance in winter.

This study examines species composition and abundance of appendicularians in the northwestern coastal waters of South China Sea based on in situ data obtained by 169 mu m planktonic nets during summer and winter, and discusses the influence of environmental factors on their distribution and assemblages. A total of 19 appendicularian species (including one unidentified species) was collected. Species richness is higher in summer than in winter, and it increases from inshore to offshore waters. Average abundance of appendicularians is 103.1 (+/-198.1) and 54.6 (+/-111.1) ind.m(-3) in summer and winter, respectively. The abundance distribution of appendicularians is generally high around inshore waters during summer and winter, and with a higher abundance assemblage along the eastern coast from Leizhou Peninsula to Hainan Island, especially at the eastern mouth of Qiongzhou Strait in summer. Oikopleurids accounted for 97.5% and 99.6% of total appendicularians abundance in summer and winter, and the region of high values was the same to that of total appendicularians abundance. Oikopleura longicauda, Oikopleura rufescens, and Oikopleura fusiformis are dominant species during summer and winter. Results showed that spatial distribution of species richness of appendicularians is considered to be the result of physical factors such as temperature and salinity in summer and winter, while variations in abundance of appendicularians are affected by the combination of physical and biological factors. In particular, variations of appendicularians abundance are affected by food availability in summer. Crown Copyright (C) 2010 Published by Elsevier Ltd. All rights reserved.

Water quality information of Beijiang River, a tributary of Pearl River in Guangdong, China, was analyzed to provide an overview of the hydrochemical functioning of a major agricultural/rural area and an industrial/urban area. Eighteen water quality parameters were surveyed at 13 sites from 2005 to 2006 on a monthly basis. A bivariate correlation analysis was carried out to evaluate the regional correlations of the water quality parameters, while the principal component analysis (PCA) technique was used to extract the most influential variables for regional variations of river water quality. Six principal components were extracted in PCA which explained more than 78% and 84% of the total variance for agricultural/rural and industrial/urban areas, respectively. Physicochemical factor, organic pollution, sewage pollution, geogenic factor, agricultural nonpoint source pollution, and accumulated pesticide usage were identified as potential pollution sources for agricultural/rural area, whereas industrial wastewaters pollution, mineral pollution, geogenic factor, urban sewage pollution, chemical industrial pollution, and water traffic pollution were the latent pollution sources for industrial/urban area. A multivariate linear regression of absolute principal component scores (MLR-APCS) technique was used to estimate contributions of all identified pollution sources to each water quality parameter. High coefficients of determination of the regression equations suggested that the MLR-APCS model was applicable for estimation of sources of most water quality parameters in the Beijiang River Basin.

This paper examines spatial and temporal variations of mesozooplankton abundance, biomass and community structure during three cruises of July 2002 (summer), January 2003 (winter), and April 2003 (spring) in the Pearl River estuary, China. Zooplankton abundance and biomass fluctuated widely and showed distinct heterogeneity in the Pearl River estuary. A total of 154 species were identified during three surveys. The number of zooplankton species richness was strongly linked to salinity. Hierarchical cluster analysis identified three zooplankton groups during this study. Estuarine, neritic and pelagic groups corresponded to the upper, middle and lower reaches in the Pearl River estuary. The difference among groups could be mainly ascribed to changes in the relative contributions of the dominant species. The fluctuations in the zooplankton abundance, biomass and community structure were determined by the interactive effects of freshwater inflow, tidal and coastal currents, chlorophyll a, salinity and temperature. Significant spatial variability in the distribution of zooplankton species, abundance and biomass can be ascribed to the virtual presence of a horizontal gradient in salinity. (c) 2005 Elsevier Ltd. All rights reserved.

A 75-year-old man with a history of partial gastrectomy with Roux-en-Y bypass 2 years earlier and cholecystectomy 9 years earlier presented with abdominal pain and fever. Computed tomography demonstrated common bile duct (CBD) dilation (Fig 1, arrowhead) and ascending cholangitis attributed to a surgical clip that had migrated into the CBD (Fig 1, arrow). Endoscopic removal was unsuccessful. Transhepatic cholangiography demonstrated a 7-mm radiolucent stone encasing the clip (Fig 2