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To assess the effect of a patient decision aid on the quality of decision-making for patients with age-related cataracts.773 patients with cataracts aged 50-80 years were randomly assigned to receive either the intervention decision aid (including standard information, quantitative information on the possible outcomes of cataract surgery and a value clarification exercise) or the control booklet (including standard information). The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and surgical intentions), which was assessed at 2 weeks after intervention via a telephone interview.The decision aid increased the proportion of participants making an informed choice, from 5.68 % in the control group to 27.7 % in the intervention group (P0.001). Compared with controls, more participants in the intervention group had adequate overall knowledge about cataract surgery (36.8 % vs. 8.79 % in controls; P0.001), and fewer participants intended to undergo surgery (22.5 % vs. 34.1 % in controls; P0.001).Use of the patient decision aid may increase the proportion of patients making informed choices. Importantly, it might also reduce the acceptance of operations.Patient decision aids represent a simple and low-cost tool to facilitate informed choice among patients with cataracts.

Background: The finance of health professional education (HPE) is of immense importance for effective and sustainable health systems, yet relevant empirical research was scarce due to the lack of financial data. The study aimed to bridge the gap by presenting the scenario of finance for health professional institutions (HPIs) of different tiers in China and exploring how the stratification of institutions affected their funding disparities.Methods: The study employed data collected from the Ministry of Education in China, and selected the HPIs mainly based on the World Directory of Medical Schools. The funding levels and disparities of China's HPIs during the period (1998–2017) were analyzed with descriptive statistics, and the indicators of funding per institution and funding per student were both considered. The average funding in HPIs was presented by tiers, and the Gini coefficient and Theil index were employed to describe the differences in financing among HPIs over the span.Results: The study found that the number of HPIs has kept growing over the past two decades, with both the funding per institution and the funding per student increasing steadily. Specifically, the average funding per institution of the three tiers increased by 31.5 times, 13.4 times, and 10.5 times separately, with the first-tier universities having an absolute advantage compared to lower tiers. As for the financing disparities among HPIs, the Gini coefficient of the funding per institution maintained to be over 0.5, with the third-tier institutions scoring the highest, while the Gini coefficient of the funding per student all ranged approximately from 0.2 to 0.3. Through the decomposition of the inequalities measured by the Theil index, the share of the between-tier difference in per-institution funding grew from 29.7 in 1998 to 77.9% in 2017.Conclusions: The funding disparities between tiers of HPIs in China gradually became more accentuated, with the top-tier institutions taking up the largest share. Although the stratified development in HPE has posed a challenge to the unified quality assurance of medical personnel training, it may also be regarded as an effective pathway for developing countries like China to achieve stable development in health professional education.

ObjectiveTo develop a theoretical framework for assessing knowledge about the possible outcomes of undergoing cataract surgery, and explore the association of knowledge level with psychological status and decision quality among patients with cataract in Southern China.MethodsThe details of the knowledge scale were based on the health education information booklet provided by National Eye Institute, NIH. We used a theory-based approach to assess gist knowledge, which comprises conceptual and numeric questions related to knowledge of the possible surgical outcomes. The scale was then used in a cross-sectional study to assess the association of knowledge score with psychological status and decision quality of cataract patients, including worry, anxiety, attitudes, intentions, decisional conflict, confidence in decision making, anticipated regret and temporal orientation.ResultsA total of 489 participants with age-related cataract were included in this study, and 10.2% (50/489) of them had adequate level of knowledge. The knowledge scale was significantly associated to the levels of worry (Odds Ratio (OR) = 0.36, 95%CI: 0.18, 0.70; P = 0.003), anxiety (beta coefficient = -5.36, 95%CI: -8.88,-1.84; P = 0.003), inaction regret (OR = 0.49, 95%CI : 0.28, 0.88; P = 0.016) and decision conflict (beta coefficient = -7.93, 95%CI: -12.81, -3.04; P = 0.002) in multivariate analyses adjusted for age, sex, education level and literacy level.ConclusionThe level of knowledge adequacy with cataract surgery outcomes is high in China and was associated with psychological status and decision quality. These findings suggest that strategies targeting knowledge of possible surgical outcomes may reduce psychological stress and improve decision quality among patients with age-related cataract.

Background/Aims: The incidence of gastric cancer (GC) ranks fifth among common tumors and GC is the third leading cause of cancer-related death worldwide. The aim of this study was to develop and validate a nomogram for predicting the overall survival (OS) of patients with GC. Methods: DNA methylation (DNAm)-driven genes were identified by integrating DNAm and gene expression profiling analyses from The Cancer Genome Atlas (TCGA) GC cohort. Then, a risk score model was built based on Kaplan-Meier (K-M), least absolute shrinkage and selector operation (LASSO), and multivariate Cox regression analyses. After analyzing the clinical parameters, a nomogram was constructed and assessed. Another cohort (GSE62254) was used for external validation. Results: Thirteen differentially expressed DNAm-driven genes were narrowed down to a six-gene signature (PODN, NPY, MICU3, TUBB6 and RHOJ were hypermethylated, and MYO1A was hypomethylated), which was associated with OS (P < 0.05) after survival and LASSO regression analyses. These differentially expressed genes (DEGs) with altered DNAm statuses were included in the prognostic risk score model. The univariate Cox regression analysis indicated that risk score, age, and number of positive lymph nodes were significantly associated with survival time in GC patients. The multivariate Cox regression analysis also indicated that these variables were significant prognostic factors for GC. A nomogram including these variables was constructed, and its performance in predicting the 1-, 3- and 5-year survival outcomes of GC patients was estimated through time-dependent receiver operating characteristic (ROC) curves. In addition, the clinical benefit of this model was revealed by decision curve analysis (DCA). Pathway enrichment analysis suggested that these DNAm-driven genes might impact tumor progression by affecting signaling pathways such as the “ECM RECEPTOR INTERACTION” and “DNA REPLICATION” pathways. Conclusions: The altered status of the DNAm-driven gene signature (PODN, MYO1A, NPY, MICU3, TUBB6 and RHOJ) was significantly associated with the OS of GC patients. A nomogram incorporating risk score, age and number of positive lymph nodes can be conveniently used to facilitate the individualized prediction of OS in patients with GC.

IntroductionMyopia is the common cause of reduced uncorrected visual acuity among school-age children. It is more prevalent in urban than in rural areas. Although many myopia studies have focused on the effect of urbanisation, it remains unclear how visual experience in urban regions could affect childhood myopia. This study aims to investigate the incidence and prevalence of myopia among school-age children in urban and rural settings, thereby identifying the environmental factors that affect the onset and progression of myopia.Methods and analysisA school-based cohort study will be conducted. We will enroll all first-grade students from an urban (10 primary schools) and a rural (10 primary schools) regions of Zhaoqing city, China. Over 3-year follow-up period, students will receive detailed eye examinations annually and complete questionnaires about living habits and environment. In a 5% random subsample of the cohort, physical activity, light intensity and eye-tracking data will be obtained using wearable devices, and high-resolution macular images will be obtained by optical coherence tomography (OCT). The primary outcome is incident myopia, defined as myopia (spherical equivalent refractive of at least −0.5D) detected during follow-up among those without myopia at baseline.Ethics and disseminationEthics approval was obtained from the ethics committee of the Zhongshan Ophthalmic Center (number: 2019KYPJ171). Study findings will be published in a peer-reviewed journal.Trial registration numberNCT04219228.

A rapid, high-performance, and accurate on-line TurboFlow ultra high performance liquid chromatography-quadrupole/Orbitrap high resolution mass spectrometry method was developed for the analysis of 46 per- and polyfluoroalkyl substances (PFAS), including 17 perfluoroalkylcarboxylic acids, 15 perfluoroalkylsulfonates, 3 fluorinated telomer sulfonates, 2 perfluoroalkyl unsaturated carboxylates, 2 perfluorooctanesulfonamidoacetic acid, 3 perfluorooctanesulfonamides, hexafluoropropylene oxide-dimer acid, ammonium 4,8-dioxa-3H-perfluorononanoate, 6:2 chlorinated polyfluorinated ether sulfonate (Cl-PFESA), and 8:2 Cl-PFESA, in human serum. The TurboFlow column, mobile phase, sample injection volume, loading flow rate, and elution time were optimized. The linearities of matrix calibration curves, method limits of quantification, accuracy and precision were investigated for method validation. Serum samples (50 μL) were precipitated with acetonitrile and directly injected into the system. The method showed good linearity (R

Background The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children’s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root–transformed self-reported anxiety scores was greater in the intervention (–0.23, 95% CI –0.27 to –0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference –0.36, 95% CI –0.63 to –0.08; P=.02). There was a significant reduction in square-root–transformed eye strain in the intervention group (–0.08, 95% CI –0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference –0.15, 95% CI –0.26 to –0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions This digital behavior change intervention reduced children’s anxiety and eye strain during COVID-19–associated online schooling. Trial Registration ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097

Acute mercury chloride (HgCl2) poisoning may lead to kidney injury, but the underlying mechanism remains largely unknown. Endoplasmic reticulum (ER) stress plays a role in some heavy metal poisoning. Whether it mediates kidney injury in acute HgCl2 poisoning remains unknown. In this study, we examined the kidney injury and the corresponding ER stress in the mouse model of different doses of acute HgCl2 poisoning. To further confirm the role of ER stress, we tested the effects of its chemical chaperone [4-phenylbutyric acid (4-PBA)]. The results revealed that acute HgCl2 poisoning caused more severe kidney injury with dose on and activated ER stress, as indicated by increased expression of GRP78 and CHOP. Inhibition of ER stress restored the functional and morphological changes of kidneys, and partly attenuated renal tubular epithelial cell apoptosis. In summary, ER stress contributes to the acute kidney injury following HgCl2 poisoning, and inhibition of ER stress may alleviate the kidney injury via reducing apoptosis.

IntroductionThe need for cataract surgery is on the rise due to our ageing population and high demands for greater visual functioning. Although the majority of patients want to participate in a shared decision-making process, no decision aid has been available to improve the quality of decision. The present study aims to determine whether a decision aid increases informed decision about cataract surgery.Methods and analysisA parallel randomised controlled trial (772 participants) will be conducted. The decision aid will be implemented among patients with any age-related cataract in Yuexiu District, which is socioeconomically representative of a major metropolitan region in Southern China. Participants will be randomly assigned to receive either a patient decision aid or a traditional booklet, and they will complete three surveys: (1) baseline assessment before the intervention (time point (T)1), 2 weeks (T2) and 1 year (T3) after the intervention. The control group receives a traditional booklet with standard general information developed by the National Eye Institute to help patients understand cataract, whereas the intervention group receives a patient decision aid that includes not only the standard general information, but also the quantitative risk information on the possible outcomes of cataract surgery as well as value clarification exercise. The primary study outcome is the informed decision, the percentage of patients who have adequate knowledge and demonstrate consistency between attitudes and intentions. Secondary outcomes include perceived importance of cataract surgery benefits/harms, decision conflict and confidence, anticipated regret and booklet utilisation and acceptability at 2 weeks, and surgical rates and a cost–utility estimate of the decision aid at 1 year.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Zhongshan Ophthalmic Center (reference number: 2019KYPJ090). Results will be published in peer-reviewed journals and presented at scientific meetings for academic audiences.Trial registration numberNCT03992807.

Shared decision making and meaningful patient involvement are key in improving cataract treatment outcomes, but no decision aid has been formally developed and validated for this purpose. Our aims were to develop a patient decision aid to guide patients’ decision about when to undergo cataract surgery, and to determine patient’s comprehension and booklet’s acceptability. The patient decision aid was developed and included evidence-based information about general cataract, its benefits, risks of treatment options, and value clarification exercise. A total of 30 patients with age-related cataract aged between 50 and 80 years were interviewed after using either the patient decision aid (n = 15) or the traditional education booklet (n = 15). The patients who received the decision aid agreed that the information was new (n = 15, 100%), the length of the aid was “just about right” (n = 13, 87%), the information was clear and easy to understand (n = 13, 87%), the decision aid was helpful in making decision (n = 13, 87%) and would like to recommend this decision aid to others (n = 14, 93%). The decision aid was assessed positively by patients with age-related cataract. There is a need for its further verification in the context of primary eye care setting.

The purpose of this study was to determine perfluoroalkyl substances (PFASs) in human serum, urine, hair and nail from general populations, and to investigate the possibility for human urine, hair and nail used as the biomonitoring sample for PFASs exposure. We detected the concentrations of PFHxA, PFOA, PFNA, PFDA, PFUnDA, PFDoA, PFHxS and PFOS in 39 matched human serum, urine, hair and nail samples from Shenzhen in China. The detection frequency and the median level of PFOS were all higher than that of the other PFASs in four matrices. The median concentration of PFOS in serum, urine, hair, and nail were 9.24ng/mL, 13.96ng/L, 0.58ng/g and 0.63ng/g, respectively. The results of spearman correlation test indicated that nail was an ideal matrix for biomonitoring PFOS rather than human urine and hair in general populations for the non-invasive sampling.

On the basis of SEER data, in which most gastric cancer patients had limited lymph node dissection, node ratio-based staging system (TNrM) has been shown to have better accuracy than the AJCC TNM system. This study is to validate the result with patients from Taiwan, where D2 lymphadenectomy is routinely performed.A total of 1405 consecutive gastric cancer patients treated at National Taiwan University Hospital between 1998 and 2010 were included. To evaluate the performance of the AJCC system, each TNM stage was stratified by TNrM stages. The homogeneity of patients' survival across TNrM strata was evaluated using the log-rank test. The performance of the TNrM system was evaluated with the same approach.Five of the 7 evaluable AJCC stages (IA, IIA, IIIA, IIIB, and IIIC) contained TNrM subgroups with statistically heterogenous survival (P=0.003, 0.04, 0.002, 0.04, and0.001, respectively). Thirty-six percent of patients (506/1405) were misclassified by the AJCC TNM system. However, of the assessable 6 TNrM stages, none of the AJCC subgroups showed significantly heterogenous survivals (P0.05). About 19% of patients (264/1405) were misclassified by using the TNrM system.Lymph node ratio significantly decreases the stage migration caused by inadequate examined lymph nodes. The advantage of TNrM was validated with a patient cohort from the Eastern medical center.

The determination of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls in blood from a non-occupational population is essential for the investigation of adverse health effects from these pollutants. In this study, a sensitive method based on programmable-temperature vaporization with large-volume injection coupled with gas chromatography with high-resolution mass spectrometry was developed to determine these pollutants in 1-2 mL of human serum samples. Various key parameters of programmable-temperature vaporization injector, including vent temperature, vent time, vent flow, transfer temperature and transfer time were optimized by factorial design. The accuracy and precision as well as applicability were assessed by determining polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls in calibration standard solutions, standard reference materials and real human serum samples from non-occupational population. The method detection limits of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls were 1.5-9.0 and 0.005-0.02 ng/kg wet weight, respectively. By comparing with typically splitless injection, the application of programmable-temperature vaporization injector could effectively lead to higher detectable rate of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls in 1-2 mL of human serum samples.

Because of the disadvantages of invasive sampling, it is desirable to explore non-invasive matrices for human biomonitoring of perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA). The aim of this study was to evaluate the application of nail, hair and urine for human biomonitoring of PFOS and PFOA. The concentrations of PFOS and PFOA in matched nail, hair, urine and serum samples collected from 64 donors were measured. The chemicals of interest were detected with high detection frequency in these matrices (90%–100%) except for PFOA in urine samples (56%). Generally, the gender influences on the levels of PFOS and PFOA in these non-invasive matrices were in agreement with that in serum. For PFOS, the coefficients of Spearman correlation between serum samples and nail, hair and urine samples were 0.786 (p

Perfluorinated compounds (PFCs) including perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) have been used in a wide range of industrial and consumer applications since 1960s. The previous studies have reported the occurrences of PFOS and PFOA in human blood and serum from various countries. In this study, 141 human whole blood samples collected from four cities around Bohai Sea in China including Qinhuangdao, Tangshan, Weihai, and Zouping were analyzed for PFCs. The highest median concentration of total PFCs was found in whole blood samples from Tangshan (14.01 ng mL(-1)). The median concentration of total PFCs in samples from Zouping (7.28 ng mL(-1)) was the lowest, but the median concentration of PFOA (3.26 ng mL(-1)) was the highest among four cities and the percentage proportion of PFOA (45%) was higher than that of PFOS (30%). Based on the different profiles of PFCs between coastal cities, it was suggested that there might be different human exposure sources and pathways of PFCs around Bohai Sea.

This study was conducted to determine the human body burden of polybrominated diphenyl ethers (PBDEs) and then clarify the relationships between that and the disruption of thyroid hormones in the general population in Northern China. Between November 2010 and May 2011, 124 serum samples were obtained from volunteers from the provinces of Shanxi and Liaoning. Serum samples were prepared by solid-phase extraction and analyzed for BDE-17, 28, 47, 66, 99, 100, 153, 154, 183 and 209 by gas chromatography-negative chemical ionization mass spectrometry. The median concentration of the total PBDEs was 7.2 ng/g lipid weights (lw); concentrations ranged from 2.1 to 160.3 ng/glw. The PBDE profiles in this study differed from those of other general populations. BDE-209 was the most abundant congener (median, 5.0 ng/glw; range, non-detected - 157.1 ng/glw), accounting for more than 75% of the total PBDEs, followed by BDE-153. The total PBDE concentrations in men were significantly higher as compared to women. The donors' age was correlated with a few PBDE congeners, but was not correlated with the total PBDE concentrations. The overall level of PBDEs in this study was lower than that observed in general populations in Southern China, Europe, and North America. There were apparent correlations between concentrations of several PBDE congeners and thyroid hormones. Triiodothyronine (T₃) was correlated with BDE-99 and 209 and inversely correlated with BDE-17, 28, 47, 153, 183, and the summed tri- to hepta-PBDE congeners (∑₃₋₇PBDEs). Thyroid-stimulating hormone (TSH) was correlated with BDE-17, 28, 47, and 183 and inversely correlated with BDE-99. No correlation between free tetraidothyronine (FT₄) and PBDEs was observed. Logistic regression analysis results indicated that those with higher levels of BDE-17 or BDE-153 had significantly lower odds of having T₃ levels above the normal range compared to those with lower levels of BDE-17 or BDE-153. Association between FT₄ and BDE-153 disappeared after controlling for sex and age. However, there was no significant association between TSH and PBDEs. The results of the present study showed that even at a relatively low level, PBDEs might interfere with the thyroid hormone levels in the general population.