Search

Abstract Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the most cost-effective option, providing an economic rationale for policymakers promoting public eye health in low- and middle-income countries.

In today’s volatile, uncertain, complex, and ambiguous (VUCA) work environments, mitigating employee burnout and turnover has become a critical concern. The enhancement of employee engagement stands out as a pivotal focus in corporate human resource management. Coaching leadership focuses on the encouragement and inspiration of employees, which can effectively stimulate the internal potential of employees, enhance work ability and enhance engagement. However, previous research on the relationship between coaching leadership style and employee engagement are limited, thus obscures the essential function in enterprise development and core competitiveness. The research collected 402 valid responses from MBA and EMBA students at the School of Business, and examines the effect of coaching leadership on employee engagement. Results indicate that coaching leadership significantly enhances multiple facets of employee engagement, including vigor, devotion, and absorption. Crucially, organizational self-esteem emerges as a mediating factor, while learning goal orientation strengthens the positive effects of coaching leadership. This research sheds light on the nuanced dynamics of effective leadership in contemporary workplaces, also it underscores the need for more nuanced, industry-specific analyses and broader exploration of moderating variables. Ultimately, the insights garnered hold profound implications for leadership training, human resource strategies, and performance metrics, emphasizing a more integrative and holistic approach to leadership and employee development in vocational contexts.

Background In adult patients with high myopia (HM), progressive axial elongation poses a significant risk for the development of subsequent ocular complications that may lead to visual impairment. Effective strategies to reduce or prevent further axial elongation in highly myopic adult patients have not been available so far. Recent studies suggested that medically lowering intraocular pressure (IOP) may reduce axial elongation.Objective This clinical randomised controlled trial (RCT) aims to evaluate the efficacy of medical IOP reduction in adult patients with progressive HM (PHM).Trial design Single-centre, open-label, prospective RCT.Methods This RCT will recruit 152 participants with PHM at the Zhongshan Ophthalmic Center (ZOC). Randomised in a ratio of 1:1, participants will receive IOP-lowering eyedrops (intervention group) or will be followed without treatment (control group) for 12 months. Follow-up visits will be conducted at 1, 6 and 12 months after baseline. Only one eye per eligible participant will be included for analysis. The primary outcome is the change in axial length (AL) within the study period of 12 months. Secondary outcomes include the incidence and progression of visual field (VF) defects, changes in optic disc morphology and incidence and progression of myopic maculopathy. Difference in AL changes between the two groups will be analysed using linear regression analysis. For the secondary outcomes, a multifactor Poisson regression within a generalised linear model will be used to estimate the relative risk of progression in VF defects and myopic maculopathy, and the rate of thinning in retinal nerve fibre layer and ganglion cell-inner plexiform will be assessed through Kaplan-Meier curves and log-rank tests.Ethics and dissemination Full ethics approval for this trial has been obtained from the Ethics Committee of ZOC, Sun Yat-sen University, China (ID: 2023KYPJ110). Results of this trial will be disseminated through peer-reviewed journals and conference presentations.Trial registration number NCT05850936.

Excessive alcohol consumption has led to the prevalence of gastrointestinal ailments. Alleviating gastric disorders attributed to alcohol-induced thinning of the mucus layer has centered on enhancing mucin secretion as a pivotal approach. In this study, foxtail millet bran polyphenol BPIS was divided into two components with MW < 200 D and MW > 200 D by molecular interception technology. Combined with MTT, cell morphology observation, and trypan blue staining, isoferulic acid (IFA) within the MW < 200 D fraction was determined as the effective constituent to mitigate ethanol-induced damage of gastric epithelial cells. Furthermore, a Wistar rat model with similar clinical features to alcohol-induced gastric mucosal injury was established. Then, gastric morphological observation, H&E staining, and assessments of changes in gastric hexosamine content and gastric wall binding mucus levels were carried out, and the results revealed that IFA (10 mg/Kg) significantly ameliorated alcohol-induced gastric mucosal damage. Finally, we applied techniques including Co-IP, molecular docking, and fluorescence spectroscopy and found that IFA inhibited the alcohol-induced downregulation of N-acetylgalactosamintransferase 2 (GALNT2) activity related to mucus synthesis through direct interaction with GALNT2 in gastric epithelial cells, thus promoting mucin synthesis. Our study lays a foundation for whole grain dietary intervention tailored to individuals suffering from alcoholic gastric mucosal injury.

Plant-derived exosome-like nanovesicles (PELNs) are bilayer membrane-enclosed nanovesicles secreted by plant cells, serving as carriers of various substances such as proteins, RNA, and metabolites. The mounting evidence suggests that PELN plays a crucial role in transmembrane signaling, nutrient transportation, apoptosis, and regulation of gut microbiota composition. This makes it a promising “dark nutrient” for plants to modulate human physiology and pathogenesis. A comprehensive understanding of PELN formation, uptake, and functional mechanisms can offer novel insights into plant nutrition and functional properties, thereby facilitating the precise development of plant-based foods and drugs. This article provides a summary of PELN extraction and characterization, as well as absorption and delivery processes. Furthermore, it focuses on the latest discoveries and underlying physiological mechanisms of PELN’s functions while exploring future research directions.

In the current era, as modern cities increasingly face environmental disasters and inherent challenges, the creation and enhancement of resilient cities have become critical. China’s urban resilience exhibits significant imbalances and inadequacies at the provincial level. This study delves into the evolution of urban resilience in various Chinese provinces, offering valuable insights for building and nurturing resilient cities. Initially, a comprehensive evaluation system for China’s urban resilience was established, incorporating 24 indicators across three key resilience aspects: resistance, adaptability, and recovery. The entropy weight method was used to develop an urban resilience evaluation model, and the Moran index and spatial cold–hot-spot analysis were applied to examine the spatiotemporal dynamics of urban resilience across China’s 31 provinces from 2012 to 2021. Moreover, the geographically and temporally weighted regression model was employed to analyze the spatial distribution of factors affecting urban resilience. The results show a general upward trend in urban resilience across Chinese provinces, with notable regional differences and concentrations. A significant decrease in urban resilience is observed from southeastern coastal cities to inland regions. The regression model highlights spatial variations in the impact of different factors, with the same factor having varying effects in different provinces. This research provides a thorough understanding of the factors influencing urban resilience in China, contributing to both theoretical and practical discussions on the topic. It lays a strong scientific groundwork for the development and advancement of resilient cities in China.

Objectives To evaluate the feasibility and accuracy of a portable, self-imaging optical coherence tomography (OCT) for measuring central subfield thickness (CST) and achieving diagnostic concordance for retinal lesions compared with clinic-based spectral-domain OCT (SD-OCT). Methods This comparative, cross-sectional study was conducted between August 2020 and February 2021. Two groups of adult participants were recruited: (1) a selected cohort of 160 participants with confirmed diagnosis and (2) a consecutive cohort of 315 participants recruited randomly. All participants underwent self-imaging OCT examination, as well as standard OCT examination. CST was automatically calculated for comparisons between the two OCT devices. Diagnostic concordance for retinal lesions and the success rate of self-imaging were assessed within the consecutive cohort. Results In the selected cohort, self-imaging OCT images yielded consistent CST with SD-OCT, with a mean difference of 0.1±7.7 pm for normal eyes, 4.9±10.6 pm for macular oedema, -1.3±9.5 pm for choroidal neovascularisation, 5.0±7.8 pm for epiretinal membrane. The self-imaging OCT also demonstrated good repeatability, with a mean test--retest difference in CST of 0.7±3.9 pm and limits of agreement ranging from -6.9 to 8.3 pm. Additionally, within the consecutive cohort, interdevice k values ranged for detecting various retinal lesions ranged from 0.8 to 1.0, except in the cases of retinal detachment (κ=0.5). All eyes (100%) in the selected cohort and 242 eyes (76.8%) in the consecutive cohort successfully completed self-imaging. Participants spent less time on self-imaging compared with SD-OCT operated by a technician (66.7±20.1 vs 73.3±32.5, p<0.01). A majority of participants (90%) found the self-imaging process 'easy' and 'comfortable'. Conclusions and relevance This study demonstrates that our self-imaging OCT and clinical-used SD-OCT are highly consistent not only in measuring the CST but also in identifying most retinal lesions. [ABSTRACT FROM AUTHOR]

Purpose To investigate genetic loci associated with ocular axial length (AL) in the Chinese population. Methods A genome-wide association study meta-analysis was conducted in totalling 2644 Chinese individuals from 3 cohorts: the Guangzhou cohort (GZ, 537 high myopes and 151 hyperopes), Wenzhou cohort (334 high myopes and 6 hyperopes) and Guangzhou Twin Eye Study (1051 participants with normally distributed AL). Functional mapping was performed to annotate the significant signals, possible tissues and cell types by integrating available multiomics data. Logistic regression models using AL-associated SNPs were constructed to predict three AL status in GZ. Results Two novel loci (1q25.2 FAM163A and 7p22.2 SDK1) showed genome-wide significant associations with AL, together explaining 29.63% of AL variance in GZ. The two lead SNPs improved the prediction accuracy for AL status, especially for hyperopes. The frequencies of AL decreasing (less myopic) alleles of the two SNPs were lowest in East Asians as compared with other populations (rs17370084: fEAS=0.03, fEUR=0.24, fAFR=0.05; rs73046501: fEAS=0.06, fEUR=0.07, fAFR=0.20), which was in line with the global distribution of myopia. The cerebral cortex and gamma-aminobutyric acidergic interneurons showed possible functional involvement in myopia development, and the galactose metabolic pathways were significantly enriched. Conclusion Our study identified two population-specific novel loci for AL, expanding our understanding of the genetic basis of AL and providing evidence for a role of the nervous system and glucose metabolism in myopia pathogenesis. [ABSTRACT FROM AUTHOR]

Aims To report the incidence and associated risk factors for developing suspected and definitive glaucoma after bilateral congenital cataract (CC) removal with a 5-year follow-up. Methods Secondary analysis of a prospective longitudinal cohort study. Bilateral CC patients who had undergone cataract surgery between January 2011 and December 2014 at Zhongshan Ophthalmic Centre were recruited. Suspected glaucoma was defined as persistent ocular hypertension requiring medical treatment. Definitive glaucoma was defined as accompanied by the progression of glaucomatous clinical features. According to postoperative lens status in 5 years follow-up: 130 eyes in the aphakia group; 219 in the primary intraocular lens (IOL) implantation group and 337 in the secondary IOL implantation group. The Kaplan-Meier survival and Cox regression analyses were used to explore the cumulative incidence and risk factors for suspected and definitive glaucoma. Results Three hundred fifty-one children (686 eyes) with bilateral CCs were enrolled in the study. The mean age at surgery was 1.82±2.08 years, and the mean follow-up duration was 6.26±0.97 years. Suspected and definitive glaucoma developed at a mean time of 2.84±1.75 years (range 0.02-7.33 years) postoperatively. The cumulative incidence of suspected and definitive glaucoma was 9.97% (35 of 351 patients), including 6.12% (42 eyes) for definitive glaucoma and 2.48% (17 eyes) for suspected glaucoma. Microcornea (HR 4.103, p<0.0001), CC family history (HR 3.285, p=0.001) and initial anterior vitrectomy (HR 2.365 p=0.036) were risk factors for suspected and definitive glaucoma. Gender, age at surgery, intraocular surgery frequency, length of follow-up and frequency of neodymium-doped yttrium aluminumaluminium garnet laser were non-statistically significant. Primary IOL implantation was a protective factor (HR 0.378, p=0.007). Conclusions Identifying suspected and definitive glaucoma after bilateral CC surgery can lower the risk of secondary blindness in children. Patients with related risk factors need to pay more attention and thus reach early intervention and treatment during clinical practice. Primary IOL implantation may be a potential protective factor, need more clinical trials to be verified. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the characteristics and associated factors of choroidal thickness (ChT) and choriocapillaris flow deficit percentage (CC FD%) in children with Marfan syndrome (MFS). Methods This is a cross-sectional study. The ChT of the subfoveal area and other areas 0.5, 1.5, and 2.5 mm away from the fovea were assessed. The CC FD% of quadrant and circular regions with diameters of 0.5, 1.5 and 2.5 mm were assessed with 3×3 mm macular choriocapillaris images. Best-corrected visual acuity (BCVA) and cardiac function factor such as Z score were measured to analyse the associations with ChT and CC FD%. Results 51 MFS children and 50 healthy controls were enrolled in this study. Compared with the healthy controls, the ChT in the MFS group was thinner in the subfoveal area, temporal 0.5, 1.5 and 2.5 mm (all p<0.001). The CC FD% was higher in circle 0.5, 1.5 and 2.5 mm (all p<0.001). Multivariate regression analysis showed that CC FD% in the circle 2.5 mm when the Z score =2 was associated with BCVA (ß=9.08 (95% CI 3.96 to 14.20); p=0.005) and Z score (ß=4.19 (95% CI 1.28 to 12.00); p=0.012). Conclusions Thinner ChT and a higher CC FD% were observed in children with MFS, and an increased CC FD% in circle 2.5 mm was significantly associated with worse BCVA and cardiac function. These findings may help identify future visual impairment and early cardiac events in MFS children. [ABSTRACT FROM AUTHOR]

In order to investigate the effect of different substrate surface roughness on the friction and wear properties of amorphous carbon films, and improve the tribological properties of the 2Cr13 sample surface under 601EF lubricating grease lubrication, the methods such as machining, polishing and other techniques were employed to prepare different surface roughness on the surface of 2Cr13 samples. Subsequently, amorphous carbon thin films were prepared on the surface of samples with different roughness by magnetron sputtering. The friction and wear properties of amorphous carbon films and silicon nitride balls under 601EF lubricating grease lubrication were investigated through ball-disc contact friction and wear tests, and the wear places were analyzed by optical microscopy. Results showed that the Si3N4 balls that rubbed against the substrate surface all presented a clear platform, while the substrate surface did not display any obvious grinding marks. The samples with the Ra range of 0.20～0.75 μm on the coupling ball had the smaller wear amount, the wear spot area range was 0.152～0.165 mm2, and the wear form was adhesive wear. By contrast, the samples with the Ra range of 0.95～3.19 μm had more wear amount on the coupling ball, the wear spot area ranging from 0.228～0.275 mm2, and there were furrow-like wear marks, which indicated more serious wear. Under the same operating conditions, as the surface roughness of the substrate increased, the starting and average friction coefficients between the two friction pairs, as well as the wear amount of Si3N4 balls, all showed a trend of first decreasing, then increasing, and then decreasing. When the Ra was 0.56 μm, the tribological performance of the amorphous carbon film was the best, and the friction curve was relatively stable, with an average friction coefficient of 0.162, and the wear amount of its coupling ball was the smallest, 0.152 mm2. In general, the surface roughness of the substrate affected the tribological performance of amorphous carbon films, and the surface with good anti friction properties could be obtained by preparing appropriate roughness on the substrate surface via the means of machining, polishing, etc.