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Buprenorphine is emerging as the preferred pharmacologic treatment for opioid use disorder during pregnancy. We examined the relative plasma clearance of buprenorphine (BUP) across pregnancy. Pregnant women with opioid use disorder participating in a prospective, observational study from 2013 to 2016 on stress in pregnancy who were receiving BUP for opioid use disorder were included. Women with an active eating disorder or suicidal ideation were excluded. Research visits occurred at 4–6-week intervals across pregnancy and the early postpartum period and included medication exposure history and blood samples. All assays for BUP serum concentrations at steady state were completed. Relative weight-adjusted clearance (Cl) was calculated using Cl = (daily dose [mg]/ body weight [kg])/serum concentration [ng/ml]. We collected 112 maternal blood samples from 29 women throughout pregnancy and the postpartum period. Serum concentrations for BUP ranged from

PurposeTo investigate the associations between body mass index (BMI) with diabetes mellitus (DM) and vision-threatening diabetic retinopathy (VTDR).MethodsThis was a longitudinal study which included DM-free participants aged ≥40 years from the Lingtou Eye Cohort Study at baseline (2008–2010). Physical and ocular examinations were performed at baseline and annual follow-ups under standardised protocol. Two 45° non-mydriatic colour digital retinal photographs were obtained for each eye at all study visits, and presence of VTDR at the 2016 follow-up was graded by a deep-learning algorithm (LableMe) with proved high accuracy for detection of VTDR.ResultsA total of 2934 participants were included with a mean (SD) age of 59.5 (7.3) years (58.3% men). Participants with incident DM (441/2934, 15%) were significantly older (pConclusionsHigher baseline BMI increased the risk of incident DM, but was not related to the risk of VTDR in this adult Chinese population.

BACKGROUND AND AIMS Reducing alcohol consumption by liver disease patients can reduce morbidity and mortality. This study compared a computer-delivered brief alcohol intervention (cBAI) with standard care in a sample of US military veterans with liver disease. DESIGN Multi-site, randomized controlled trial of a cBAI plus standard care (n = 67) versus standard care only (n = 71). Participants were assessed at baseline and 3- and 6-month follow-up. SETTING US Veterans Health Administration liver clinics. PARTICIPANTS Participants were mostly male and diagnosed with hepatitis C. INTERVENTIONS AND COMPARATORS A cBAI tailored to veterans with liver disease and consisting of assessment and personalized feedback. Standard care was brief education and advice about alcohol and liver disease. MEASUREMENT Primary outcomes were self-reported number of drinking days and unhealthy drinking days (defined as more than two drinks for men and more than one for women) in the past 30 days at 6-month follow-up. Secondary outcomes were these two variables at 3-month follow-up, and drinks consumed per drinking day, depression and overall health at 3- and 6-month follow-ups. Missing data were imputed using multiple imputation. FINDINGS Compared with standard care, cBAI participants reported significantly fewer drinking days at 6-month follow-up and fewer unhealthy drinking days at both 3- and 6-month follow-ups. Least square means (LS-means) for number of drinking days were 3.78 for the cBAI condition and 6.89 for the standard care condition at 6 months [LS-mean ratio = 3.78/6.89 = 0.55, 95% confidence interval (CI) = 0.34, 0.89]. LS-means for number of unhealthy drinking days were 1.04 for the cBAI condition and 2.57 for the standard care condition at 3-month follow-up (LS-mean ratio = 1.04/2.57 = 0.41, 95% CI = 0.19, 0.85). At 6-months follow-up, LS-means were 1.18 for the cBAI condition and 2.75 for the standard care condition (LS-mean ratio = 1.18/2.75 = 0.43, 95% CI = 0.20, 0.91). CONCLUSIONS A computer-delivered brief alcohol intervention reduced drinking days and unhealthy drinking days at 6-month follow up in military veterans with liver disease compared with brief education and advice to reduce consumption.

In this retrospective study, we aimed to evaluate the efficacy of percutaneous catheter drainage (PCD) in patients with acute pancreatitis (AP) for management of pancreatic fluid collections (PFCs). A total of 111 AP patients were included with 34 patients in conservative treatment group (received nutrition support and liquid resuscitation during hospitalization) and 77 patients in PCD group (accepted PCD during hospitalization). The APACHE II score, CRP value, procalcitonin (PCT) value, and WBC count of included patients were recorded for further comparison. The inflammation response of patients in both groups was assessed by measuring the mean time for the recovery of CRP level, WBC count, and amylase/lipase. Mortality, length of hospital stay, new-onset ICU admission or readmission, and new-onset multi-organ failure were also compared between the two groups. The pre-conditions of patients in both groups indicate the comparison of the two groups. The inflammatory response in PCD group was attenuated when compared with conservative treatment group evidenced by decreased mean time for recovery of CRP level in PCD group. In addition, patients in PCD groups had less complication rate (multi-organ failure and surgical debridement) than that in conservation treatment group. Patients in conservation treatment group had shorter hospital stay, but failed to achieve statistical significance. Evidence supported that PCD is an effective approach for management of PFCs after conservation treatment failure with decreased complication rate and attenuated inflammation responses.

Sepsis, a life-threatening systemic syndrome related to inflammatory response, usually accompanied by major organ dysfunctions. The aim of the present study was to elucidate the role by which Shengmai injection (SMI) acts to septic cardiomyopathy. Initially, the induced mice with septic cardiomyopathy were treated with SMI or normal saline (NS) with oe-caspase-3, and HL-1 cells were treated with oe-Beclin-1 and oe-caspase-3 and then cultured with lipopolysaccharide (LPS). Subsequently, we measured the cardiac troponin I (cTnI) level, and expression of mitochondrial autophagy protein (parkin and pink1) and myocardial cell autophagy-related proteins (LC3-II and LC3-I). Additionally, we identified the cleavage of Beclin-1 by caspase-3 and detected the changes of mitochondrial membrane potential, level of reactive oxygen species (ROS), and apoptosis of myocardial cells in myocardial tissues of mice. It has been demonstrated that SMI contributed to the increase of myocardial mitochondrial autophagy, reduction of cTnI level, and elevation of mitochondrial membrane potential in septic cardiomyopathy mice. Both in vitro and in vivo experiments showed that caspase-3 promoted cleavage of Beclin-1 and release of ROS, whereas repressed lipopolysaccharide (LPS)-induced mitochondrial autophagy. Furthermore, the facilitation of myocardial mitochondrial autophagy and protection of myocardial mitochondria by SMI through inhibition of cleavage Beclin-1 by caspase-3 in septic cardiomyopathy mice were also proved by in vivo experiments. Taken together, SMI could protect myocardial mitochondria by promoting myocardial mitochondrial autophagy in septic cardiomyopathy via inhibition of cleavage of Beclin-1 by caspase-3. Our study demonstrates that SMI could represent a novel target for treatment of septic cardiomyopathy.

Ginsenoside-Rg1 (G-Rg1), a saponin that is a primary component of ginseng, is effective against inflammatory diseases. The P2X purinoceptor 7 (P2X7) receptor is an ATP-gated ion channel that is predominantly expressed in immune cells and plays a key role in inflammatory processes. We investigated the role of G-Rg1 in sepsis-related cardiac dysfunction and the underlying mechanism involving the regulation of the P2X7 receptor. We detected cell viability, cytotoxicity, cellular reactive oxygen species (ROS) levels, and mitochondrial membrane potential (MMP) with or without G-Rg1 in lipopolysaccharide (LPS)- or hypoxia/reoxygenation (H/R)-induced H9c2 cell models of ischemia/reperfusion injury. We applied cecal ligation and puncture (CLP) to induce a mouse model of sepsis and measured the survival duration and cardiac function of CLP mice. Next, we quantified the ROS level, MMP, respiratory chain complex I-IV enzymatic activity, and mitochondrial fusion in CLP mouse heart tissues. We then investigated the role of G-Rg1 in repairing LPS-induced cell mitochondrial damage, including mitochondrial superoxidation products. The results showed that G-Rg1 inhibited LPS- or H/R-induced cardiomyocyte apoptosis, cytotoxicity, ROS levels, and mitochondrial damage. In addition, G-Rg1 prolonged the survival time of CLP mice. G-Rg1 attenuated LPS-induced superoxide production in the mitochondria of cardiomyocytes and the excessive release of cytochrome c from mitochondria into the cytoplasm. Most importantly, G-Rg1 suppressed LPS-mediated induction of proapoptotic Bax, activated Akt, induced GSK-3β phosphorylation, and balanced mitochondrial calcium levels. Overall, G-Rg1 activates the Akt/GSK-3β pathway through P2X7 receptors to inhibit sepsis-induced cardiac dysfunction and mitochondrial dysfunction.

IMPORTANCE: The conventional 2.2-mm clear corneal incision is relatively narrow compared with the sleeves of Phaco handpieces, resulting in friction at the incision site and increased risk of incision-related Descemet membrane detachment (DMD). The modified 2.2-mm incision only enlarged internal width to 3.0 mm, forming a trapezoid incision shape, which may reduce the friction of surgical instruments and decrease the risk of incisional DMD. OBJECTIVE: To compare the incidence of incision-related DMD between eyes undergoing modified vs conventional 2.2-mm incision phacoemulsification for hard nuclear age-related cataract. DESIGN, SETTING, AND PARTICIPANTS: This double-masked, parallel randomized clinical trial was conducted from July 22, 2019, to January 22, 2020, at Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. The study included patients with age-related cataract and nuclear opalescence grade of 4.0 or greater based on the Lens Opacities Classification System III. Patients were enrolled in this study according to the following inclusion criteria: (1) age between 65 to 90 years; (2) pupil size of 6 mm or greater after dilation; (3) Lens Opacities Classification System III nuclear opalescence grade of 4.0 or more; and (4) corneal endothelial cell density greater than 1500 cells/mm(2). INTERVENTIONS: Modified (enlarged internal width to 3.0 mm) or conventional 2.2-mm incision phacoemulsification with intraocular lens implantation. MAIN OUTCOMES AND MEASURES: Incidence of incision-related DMD at postoperative day 1. RESULTS: A total of 130 eyes of 130 patients were randomized into the conventional group (n = 65) or the modified group (n = 65). The mean (SD) age of participants was 74.5 (5.9) years and 74.3 (6.0) years in the conventional and modified groups, respectively. A total of 26 participants in the conventional group (40%) and 27 in the modified group (42%) were men. Compared with eyes in the conventional group, the incidence of DMD in eyes in the modified group was significantly lower at postoperative day 1 (difference, 26.15; 95% CI, 9.60-42.71; P = .003). The difference at postoperative day 7 was 16.92 (95% CI, 2.91-30.94; P = .02). The length of DMD (postoperative day 1: difference, 0.188; 95% CI, 0.075-0.301; P = .002) and maximal corneal thickness at incision site (postoperative day 1: difference, 0.032; 95% CI, 0.006-0.057; P = .02; postoperative day 7: difference, 0.019; 95% CI, 0.003-0.035; P = .02) were lower in the modified group, while visual quality parameter modulation transfer function (postoperative day 1: difference, −0.033; 95% CI, −0.064 to −0.001; P = .04) was higher. No difference was observed between the 2 groups in best-corrected visual acuity, central corneal endothelium loss, or surgically induced astigmatism at any follow-up time. There were no intraoperative complications in the 2 groups. CONCLUSIONS AND RELEVANCE: These findings suggest that modified 2.2-mm trapezoid incision phacoemulsification reduces the incidence of DMD for hard nuclear age-related cataract at postoperative day 1 and might be considered in patients at high risk of incision-related DMD, although the clinical relevance cannot be determined with certainty from this trial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04014699

AIMS To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon). DESIGN, SETTING AND PARTICIPANTS Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%). INTERVENTION AND COMPARATOR AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs. MEASUREMENTS Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months. SECONDARY OUTCOMES number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition. FINDINGS There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [β = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (β = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition. CONCLUSIONS Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship.

PURPOSE: To compare outcomes of in-the-bag versus ciliary sulcus secondary intraocular lens (IOL) implantation for pediatric aphakia. DESIGN: Prospective interventional case series. METHODS: SETTING: institutional. PATIENT: Two hundred and two children (355 aphakic eyes) diagnosed as congenital cataracts and undergoing cataract extraction before 24 months of age. INTERVENTION: Pediatric aphakic eyes underwent either in-the-bag or ciliary sulcus secondary IOL implantation according to the amount of residual lens capsule and were followed for three years postoperatively. MAIN OUTCOME MEASURES: Adverse events (AEs), IOL tilt and decentration, best corrected visual acuity (BCVA) in operative eye. RESULTS: One hundred forty-four eyes (40.6%, 89 children) received in-the-bag IOL implantation (capsular group) and 211 (59.4%, 132 children) underwent ciliary sulcus IOL implantation (sulcus group). Kaplan-Meier curves showed that the time-dependent incidence of glaucoma-related adverse events (GRAEs) (P=0.005) and any AEs (P=0.002) were higher in the sulcus group. In-the-bag IOL implantation was a strong protective factor against GRAE (HR, 0.08, 95CI:0.01∼0.53; P=0.009) and any AEs (HR, 0.21 95CI: 0.08∼0.57; P=0.002). Clinically significant IOL decentration (>0.4mm) was more common in the sulcus group compared to the capsular group (vertical decentration: 29.8% vs. 15.7%, P=0.005; horizontal decentration: 30.3% vs. 9.35%, P

Background This study compared a computer and manual version of a tailored Coordinated Anxiety Learning and Management (VA CALM) protocol on provider fidelity to CBT and patient outcomes. Methods This study was a cluster randomized controlled trial. Providers ( N = 32) were randomized to deliver VA CALM by computer or manual. Veteran patients ( N = 135), treated by study providers, were recruited. The primary outcome was CBT fidelity, measured by rating audiotaped sessions. Secondary outcomes were Veterans’ general (BSI-18 GSI, SF-12) and disorder-specific (GAD-7, PCL-5, PHQ-9) outcomes assessed at baseline, three and six month follow-up. Results We found a large ( d = 0.88) but not statistically significant difference in mean fidelity rating scores between conditions. Compared with the manual, participants with generalized anxiety disorder receiving VA CALM by computer reported lower GAD-7 scores at three (-5.88; 95% CI =-11.37, -0.39) and six month (-5.25; 95% CI =-10.29,-0.22) follow-ups ( d = 0.37 to 0.55). Participants in the computer and manual conditions reported lower PHQ-9 (-3.11; 95% CI =-5.51, -0.71; -4.06; 95% CI= -7.22,-0.90, respectively) and BSI-18 GSI (0.78; 95% CI =0.68,0.90; 0.71; 95% CI =0.58, 0.87, respectively) scores from baseline to six month follow-up. We did not find statistically significant differences over time or between conditions on SF-12 or PCL-5 scores. Limitations This study was underpowered to test the primary outcome. Small samples sizes in the disorder-specific subgroup analysis may limit the generalizability of findings. Conclusions Neither modality proved to be superior on VA CALM fidelity. The computer version of VA CALM, compared to the manual, may provide modest benefit to Veterans with GAD.

Background/aimsTo evaluate the associations of dietary consumption with the 10-year incidence of diabetic retinopathy (DR) progression in working-aged Australians with diabetes.MethodsWe obtained longitudinal data of all diabetic subjects aged 45–65 years from the baseline of the 45 and Up Study and linked this data with Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme claims until 2016. Retinal photocoagulation (RPC), as determined based on the MBS data, was used as a proxy measure of DR progression. Dietary measurements were assessed via self-reported consumption of meat, dairy products, whole-meal bread, breakfast cereal, vegetables, fruit and fruit juice using a self-administered questionnaire at baseline. Cox regression was used to assess the association between dietary consumption and incident RPC during the follow-up period.ResultsA total of 8122 participants were included in the current analysis with a mean age of 57.2±5.2 years. During a mean follow-up of 8.6 years, 314 participants (3.8% of baseline) received RPC. Higher consumption of cheese and whole-meal bread was associated with a lower risk of incident RPC, with the HRs of the highest quartiles versus the lowest being 0.58 (95% CI 0.41 to 0.83; test for trend, p=0.007) and 0.64 (0.46 to 0.89; p=0.04), respectively. Body mass index, insulin treatment and gender were significant modifiers for the association between cheese/whole-meal bread and RPC.ConclusionConsumption of cheese and whole-meal bread could reduce the risk of DR progression among the working-aged Australian population with diabetes.

Background Long noncoding RNAs (lncRNAs) have been revealed to participate in cellular biological processes in multiple diseases, including asthma. Nevertheless, the role of lncRNA TCF7 (lncTCF7) in airway smooth muscle cells (ASMCs) is still covered. Methods The expression of lncTCF7 and TIMMDC1 in ASMCs from 12 asthma patients and 12 healthy controls were detected using qRT-PCR. Then MTT assay, EdU assay and transwell assay were conducted respectively to assess the impact of lncTCF7 on ASMCs viability, proliferation and migration. Besides, western blotting was performed to determine the protein levels of TIMMDC1 and AKT/p-AKT. Results We discovered that lncTCF7 and TIMMDC1 were upregulated in asthma groups and lncTCF7 improved ASMCs viability/proliferation and migration. In addition, lncTCF7 regulated TIMMDC1 expression indeed and PDGF-BB treated ASMCs exhibited elevated levels of lncTCF7 and TIMMDC1. Moreover, lncTCF7 suppression diminished both the mRNA and protein levels of TIMMDC1 and markedly reduced p-AKT level which could be enhanced under TIMMDC1 overexpression. Finally, both TIMMDC1 overexpression and AKT activator could restored the inhibitory impacts of lncTCF7 silence on PDGF-BB treated ASMCs. Conclusion Our study uncovered that lncTCF7 facilitated human ASMCs growth and migration via targeting TIMMDC1 thus activating AKT signaling, providing a novel possible target for asthma therapy.

To examine the impact of diet on the incidence of cataract surgery among the working-aged diabetic population in Australia.This cohort study was conducted among 8,752 participants with diabetes aged 45-65 years who were recruited to the 45 and Up Study from 2006 to 2016. The data was linked to the Medicare Benefits Schedule to obtain data on cataract surgery. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on Pharmaceutical Benefits Scheme. Diet was assessed at baseline, using a self-administered questionnaire and healthy diet scores were calculated based on Australian Dietary Guidelines. Cox regression was used to evaluate the association between diet and the incidence of cataract surgery during the follow-up.During a mean follow-up of 8.4 years (73,431 person-years), 914 diabetic participants underwent cataract surgery with a corresponding rate of 12.4 cases per 1,000 person-years. After adjusting for age and gender, the hazard ratios (HR) of cataract surgery for the highest compared to the lowest intake quintile of red meat and poultry were 1.24 (95% CI, 1.00-1.55) and 1.24 (95% CI, 1.02-1.51), respectively. Further adjustment for demographic, lifestyle and dietary factors resulted in no significant difference between cataract surgery risk and healthy diet scores or specific diet groups. In gender-stratified analyses, increasing consumption of red meat (HR for highest versus lowest quintile, 1.39; 95% CI, 1.00-1.93; P for trend = 0.01) and poultry (HR for highest versus lowest quintile, 1.40; 95% CI, 1.05-1.87; P for trend = 0.01) were associated with a higher risk of cataract surgery in women after adjustment of age, gender, income, education level, body mass index, hypertension, cardiovascular disease, family history of diabetes, diabetes duration, insulin use, lifestyle, and other dietary factors.Higher consumption of red meat and poultry is related to an elevated risk of cataract surgery in the working-aged female population with diabetes.

IntroductionThis study aims to explore the effect and mechanism of miR�489-3p on the proliferation and apoptosis of pancreatic acinar cells in acute pancreatitis (AP).Material and methodsX-linked inhibitor of apoptosis protein (XIAP) and miR-489-3p expression in serum of AP patients, pancreatic AR42J cells, and rat AP tissues were measured using quantitative reverse transcription poly�merase chain reaction and western blot. The effect of miR-489-3p on pro�liferation and apoptosis was determined by MTT assay and flow cytometry. The relationship between XIAP and miR-489-3p was verified using luciferase assay RNA immunoprecipitation assay. Histological changes in rat pancreatic tissues were observed via haematoxylin and eosin staining.ResultsMeasurement of miR-489-3p and XIAP expressions in AP patients revealed a negative correlation between miR-489-3p and XIAP. Increased miR-489-3p expression in AP patients indicated a poor prognosis. Cerulein was used to induce AP in AR42J cells and standard deviation rats. Exper�iments in cells and AP rat models showed that miR-489-3p can increase cell apoptosis and inhibit cell proliferation by regulating XIAP, as shown by elevated expressions of pro-apoptotic proteins (p53 and Bax) and decreased expression of proliferation indicator (Ki-67) after transfection of miR-489- 3p mimics. Meanwhile, knockdown of miR-489-3p abrogated the inhibitory effects of miR-489-3p on cell proliferation and the promotion on cell apop�tosis. Luciferase assay and RNA immunoprecipitation assay confirmed that XIAP can directly bind miR-489-3p.ConclusionsWe concluded that miR-489-3p modulates cell proliferation and apoptosis in AP by targeting XIAP. Given that high expression of miR�489-3p in AP indicated poor prognosis, it raises the possibility that miR�489-3p might be a novel and valuable therapeutic target and a prognosis indicator for AP.

The patient’s Cr (creatinine), BUN (blood urea nitrogen), HBG (hemoglobin), VT (ventricular tachycardia), pacing frequency, puncture point, emergency to permanent pacing time, pacing current (mA), pacing threshold current (mA), and admission diagnosis data were collected. The data were subjected to frequency statistics, curve regression analysis, PLS regression analysis, adjustment analysis, chi-square test, ridge regression analysis, discriminant analysis, negative binomial regression analysis, Poisson regression analysis, and stepwise regression analysis. Some findings include the following: (1) Cr has a significant positive effect on HBG, and BUN has a significant negative effect on HBG. (2) VT has a negative correlation with age and a positive correlation with CK-MB and CK (creatinine kinase). (3) Myocarditis has a negative correlation with age and a significant positive correlation with CTnI (cardiac troponin I). (4) AST (aspartate transaminase) and ALT (alanine aminotransferase) have a significant positive impact on DDI (D-dimer), while CTnI has a significant negative impact on DDI. MYO (myoglobin) has no impact relationship to DDI. (5) ALT has a significant positive relationship with APTT (partial thromboplastin time). (6) Alb (albumin) and TBIL (total bilirubin) have a significant positive effect on PLT (platelet) count, while pro-BNP (B-type natriuretic peptide) and MYO have a significant negative effect on PLT. (7) CK has a significant positive effect on INR (international normalized ratio). (8) The relationship between sinus node dysfunction and VT significantly affect the pacing frequency (beats/minute). For third-degree atrioventricular block, different samples of sinus node dysfunction showed significant differences. (9) There is a significant positive correlation between pacing current (mA) and pacing threshold current (mA). (10) There was a significant positive correlation between perceived voltage (mV) and the time from emergency to permanent pacing. Admission diagnosis has a significant positive impact on the time from emergency to permanent pacing. The change (increase) in time from emergency to permanent pacing was 1.137-fold when an additional condition was diagnosed on admission.

Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread worldwide. Methods: This was a retrospective case series involving 218 patients admitted to three tertiary hospitals in the Loudi, Shaoyang, and Xiangtan areas of China from January 21 to June 27, 2020, who were confirmed by RT-PCR to have SARS-CoV-2. The patients' clinical characteristics, laboratory results, treatments, and prognoses based on clinical classification were recorded. Poor outcome was defined as admission to an ICU, the use of mechanical ventilation, or death. Results: The patients were classified into four clinical groups based on disease severity, namely mild (10/218, 5%), moderate (146/218, 67%), severe (24/218, 11%), or critical (14/218, 6%); 24 (11%) asymptomatic cases were also included in the study. The most common symptoms were self-reported cough (162/218, 74%), fever (145/218, 67%), sputum production (99/218, 45%), and fatigue (77/218, 35%). Among the 218 patients, 192 (88%) received lopinavir/ritonavir and interferon-alpha inhalation, and 196 (90%) patients received traditional Chinese medicine. Among the severe and critical patients, 25 (11%) were admitted to an ICU with or without mechanical ventilation, and one patient died. The presence of diabetes [relative risk (RR), 3.0; 95% CI, 1.3-6.8; p = 0.007) or other comorbidities (RR, 5.9; 95% CI, 1.9-17.8; p = 0.002) was independently associated with poor outcome. To date, 20 (9%) patients have retested positive for SARS-CoV-2 RNA after recovering and being discharged. Conclusion: The majority of patients in this case series were clinically classified as having moderate COVID-19. Older patients tended to present with greater levels of clinical severity. The prognosis for patients who were elderly or had diabetes or other chronic comorbidities was relatively poor.

AimTo investigate the association between physical activity (PA) and incidence of cataract surgery among patients with diabetes.MethodsWe obtained data from all diabetic subjects aged 45-65 years from the baseline of the prospective 45 and Up Study from 2006 to 2009 and linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) until 2016. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on PBS. Cataract surgery was determined based on the MBS, and metabolic equivalent intensity level number of PA sessions per week was used to assess PA. Cox regression was used to assess the association between baseline PA and cataract surgery during the follow-up.ResultsA total of 9113 diabetic participants in the 45 and Up Study were included in the current analysis with a mean age of 57.3±5.2 years (43.6% female). During a mean follow-up of 8.8 years, 950 participants (10.4% of baseline) received cataract surgery with a corresponding incidence of 12.4/1000 person-years. Cox regression analysis showed that people with less PA (p=0.01), older age (pConclusionsMore vigorous PA was independently associated with a reduced risk of cataract surgery in working-aged patients with diabetes.

IMPORTANCE: Understanding the longitudinal intraocular pressure (IOP) changes and potential risk factors in adults is important for future glaucoma control in the aging society. BACKGROUND: Limited longitudinal studies exist in Asia investigating the longitudinal IOP changes and with varying results. DESIGN: Population-based cohort study. PARTICIPANTS: 1405 baseline participants from the Liwan Eye Study. METHODS: All baseline participants were invited for the 10-year follow-up examination in 2013. IOP (by Tonopen), central corneal thickness (CCT; by ultrasound), refractive error (by autorefractor), blood pressure, height and weight were measured per standardized protocol and the presence of hypertension or diabetes was collected by questionnaire. Follow-up examinations were conducted using the same equipment with proper calibration. Linear regression analysis was used to assess the association between IOP change and potential risk factors. MAIN OUTCOME MEASURES: 10-year IOP change. RESULTS: Of the 791 participants at the 10-year follow-up, IOP data were available for 602 participants with a mean age of 60.9 years (55.5% female). The average IOP change over 10 years was an increase of 1.44 mmHg (95% confidence interval, 1.12-1.75). Linear regression showed that 10-year IOP change was not associated with baseline age, gender, body mass index (BMI), CCT, spherical equivalence (SE), hypertension or diabetes. However, it was positively associated with longitudinal increase of BMI when longitudinal changes of BMI and SE were included in the model (P < 0.001). CONCLUSIONS AND RELEVANCE: We observed a small increase in IOP over 10 years in this adult Chinese population, which was positively related to the longitudinal change in BMI.

Purpose: To analyze subclinical keratoconus topography indexes using Pentacam and Orbscan-II measurements to identify evidences for seeking sensitive indexes to screen and diagnose subclinical keratoconus. Methods: Fifty healthy participants (50 eyes) and 40 patients with subclinical keratoconus (40 eyes) were included. Seven common parameters including corneal thickness at the thinnest point; minimum curvature of the front surface (minimum simulated keratometry value, SimK’s Min); maximum curvature of the front surface (maximum simulated keratometry value, SimK’s Max); the frontal corneal surface best-fit spherical radius of the curvature; the back corneal surface best-fit spherical radius of curvature; the anterior corneal surface height (anterior Diff value); and the posterior corneal surface height (posterior Diff value) measured by Pentacam and Orbscan-II between normal and subclinical keratoconus eyes were compared. Results: Statistical differences between the healthy and subclinical keratoconus groups (p

Patient: Female, 54 Final Diagnosis: Multiple myeloma Symptoms: A 9-month history of blurred vision Medication: Systemic chemotherapy with vincristine • cyclophosphamide • dexamethasone Clinical Procedure: Multiple myeloma patient presenting with corneal opacity and blurred vision as chief complaint Specialty: Ophthalmology and Hematology Objective: Rare disease Background: A multiple myeloma patient presenting with corneal opacity and blurred vision as chief complaint is rare. Case Report: A 54-year-old woman with a 9-month history of blurred vision without other systemic symptoms consulted an ophthalmologist. The patient had bilateral diffuse corneal opacity at the corneal epithelium and anterior stroma under slit-lamp examination. Decreased corneal endothelial cells density was found by microscopy. During consultation, the patient was noted to have an anemic face. Laboratory analysis and bone marrow were investigated. Serum protein electrophoresis revealed a raised serum kappa paraprotein band (12.4 g/L). The erythrocyte sedimentation rate (ESR) was accelerated to 49 mm/h (normal

IMPORTANCE: Longitudinal data on visual outcome of correctable visual impairments (VI) are of paramount importance for decision-maker to estimate burden and demand to treat avoidable VI. BACKGROUND: To assess the 5-year visual outcome among participants with correctable VI and to identify associated risk factors. DESIGN: Population-based longitudinal cohort study. PARTICIPANTS: Participants with correctable VI at baseline attended the 5-year follow-up visit of the Liwan Eye Study. METHODS: Presenting visual acuity (PVA) with habitual refractive correction was assessed using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Then participants with PVA

Patient: Female, 21 Final Diagnosis: Valsalva retinopathy Symptoms: Sudden visual loss due to twin-pregnancy Medication: None Clinical Procedure: Conservative treatment of valsalva retinopathy with good and careful prognosis Specialty: Ophthalmology Objective: Uncommon and rare case Background: Valsalva retinopathy is a rare but sight-threatening condition with sudden visual loss. Twin-pregnancy is known as a confirmed risk factor for Valsalva retinopathy. Case Report: A 21-year-old twin-pregnant Chinese woman with 31 weeks of gestation complained of a sudden decrease of visual acuity in her right eye for five hours. Based on the patient’s medical history, clinical findings, laboratory testing and optical coherence tomography (OCT) imaging studies, Valsalva retinopathy was confirmed. Initially, we managed the patient with Nd: YAG (neodymium-doped yttrium aluminum garnet) laser to puncture the posterior portion of the vitreous. As the laser failed to puncture the posterior hyaloid face due to dense premacular hemorrhages, we switched to conservative treatment. We reviewed the case with the patient 12 weeks after an uneventful vaginal delivery. Her right visual acuity had spontaneously increased to 6/6 with no active medical intervention. Conclusions: Valsalva retinopathy can be caused by twin-pregnancy. Patients with Valsalva retinopathy can be managed conservatively with careful prognosis following failed laser treatment. Ophthalmologists and obstetrician should coordinate properly and pay more attention to Valsalva retinopathic patients with twin-pregnancy.

PurposeTo describe the prevalence of age-related macular degeneration (AMD) among older adults in rural southern mainland China.MethodsEligible persons aged 50 years or over were identified by geographically defined cluster sampling from Yangxi County, Guangdong Province, China. Participants underwent a standardised interview and comprehensive eye examinations from August to November in 2014. Digital retinal photographs were graded for AMD lesions using the Clinical Classification of Age-Related Macular Degeneration developed by the Beckman Initiative for Macular Research Classification Committee. Age-standardised prevalence of AMD and AMD lesions was calculated using the 2010 world population data and compared with those of other populations.ResultsOf 5825 subjects who participated (90.7% response rate), 4881 (83.8%) had fundus photographs gradable for AMD. Early, intermediate and late AMD were present in 2003 (41.0%), 879 (18.0%) and 42 (0.86%) participants. The age-standardised prevalence of early, intermediate and late AMD was 40.4% (95% CI 39.6% to 41.2%), 17.6% (95% CI 17.0% to 18.2%) and 0.79% (95% CI 0.65% to 0.95%), respectively. Total AMD was more prevalent in men than in women (62.8% vs 57.1%).ConclusionsAMD is an important public health concern for rural southern China, and the prevalence of AMD was higher in men than in women.

Heart rate variability is a physiological measure associated with autonomic nervous system activity. This study hypothesized that lower pre-deployment HRV would be associated with higher post-deployment post-traumatic stress disorder (PTSD) symptoms. Three-hundred-forty-three Army National Guard soldiers enrolled in the Warriors Achieving Resilience (WAR) study were analyzed. The primary outcome was PTSD symptom severity using the PTSD Checklist – Military version (PCL) measured at baseline, 3- and 12-month post-deployment. Heart rate variability predictor variables included: high frequency power (HF) and standard deviation of the normal cardiac inter-beat interval (SDNN). Generalized linear mixed models revealed that the pre-deployment PCL*ln(HF) interaction term was significant (p < 0.0001). Pre-deployment SDNN was not a significant predictor of post-deployment PCL. Covariates included age, pre-deployment PCL, race/ethnicity, marital status, tobacco use, childhood abuse, pre-deployment traumatic brain injury, and previous combat zone deployment. Pre-deployment heart rate variability predicts post-deployment PTSD symptoms in the context of higher pre-deployment PCL scores.

Purpose To describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home). Methods Three study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. V@home VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability. Results The mean difference between V@home and ETDRS distance VA across all groups ranged from -0.010 to -0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of V@home with near ETDRS VA across all groups, with a mean difference of -0.092 to -0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: -0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: -0.289 to 0.258 for distance and -0.235 to 0.199 for near). The majority of participants were satisfied with V@home. Conclusions V@home could accurately and reliably measure both distance and near VA and is well accepted by participants. Translational relevance The V@home system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.

Background: The aim of this study is to examine the association of physical activities (PA) with DR progression based on 10 years follow-up on a large cohort of working-age diabetic patients in Australia. Methods: Nine thousand and eighteen working-age diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (

ObjectiveTo examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia.MethodsNine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (ResultsIn the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61–0.98; high vs. low, HR = 0.61, 95%CI: 0.36–0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC.ConclusionsHigher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.

Objective To evaluate the beneficial effects of hydroxysafflor yellow A (HSYA) on monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) in rats, and to investigate the main pathophysiological mechanism of HSYA in preventing development of MCT-induced PAH. Methods Four groups (control, control with HSYA treatment, MCT-exposed, and MCT-exposed with HSYA treatment) were evaluated at day 28 following MCT exposure. Haemodynamic measurements, right ventricular hypertrophy, morphometry, inflammatory cytokines and oxidant expression were assessed. Results HSYA significantly reduced haemodynamic changes, right ventricular hypertrophy and morphometric changes induced by exposure to MCT. HYSA also suppressed MCT-induced inflammation and oxidative stress in rat pulmonary tissue. Conclusions Experimental MCT-induced PAH may be reduced by HSYA treatment, and the mechanism may involve suppression of inflammation and oxidative stress.

AIM: To investigate the influence of astigmatism on visual acuity in school-aged children, and to define a cutoff for clinically significant astigmatism. METHODS: This is a population-based, cross-sectional study. Among 5053 enumerated children aged 5-15y in Guangzhou, 3729 (73.8%) children aged 7-15 with successful cycloplegic auto-refraction (1% cyclopentolate) and a reliable visual acuity measurement were included. Ocular measurement included external eye, anterior segment, media and fundus and cycloplegic auto-refraction. Primary outcome measures included the relationship between severity and subtypes of astigmatism and the prevalence of visual impairment. Three criteria for visual impairment were adopted: best-corrected visual acuity (BCVA) ≤0.7, uncorrected visual acuity (UCVA) ≤0.5 or

ObjectivesTo investigate the longitudinal changes in intraocular pressure (IOP) and its associations with refractive error and systemic determinants in a Chinese geriatric population.DesignProspective cohort study.SettingGuangzhou Government Servant Physical Check-up Center, Guangzhou, China.Participants4413 government employees aged no less than 40 years (41.9% female) attending annual physical and eye examinations were included in this study. The inclusion criterion was having attended the 2010 follow-up examination. The exclusion criteria include glaucoma or intraocular surgery history, IOP >21 mm Hg at any visit or without available IOP data at all visits from 2010 to 2014.Primary and secondary outcome measuresThe outcome measure was IOP at each follow-up visit from 2010 to 2014. Mixed-effect model was used to assess the relationship between longitudinal changes in IOP and potential risk factors.ResultsFor the 2653 participants who had available IOP data at both the 2010 and 2014 follow-up visits, the average change in IOP was an increase of 0.43 (95% CI 0.36 to 0.50) mm Hg. For the whole study population and in the optimised mixed model, there was a non-linear increase of IOP with age (PConclusionsIn this cohort of elderly Chinese adults, IOP increases non-linearly with ageing. People with increasing blood pressure, BMI, FPG and myopic progression are more likely to have IOP elevation over time.

Mood disorders affect large numbers of individuals and their families; the ripple effects on relationship functioning can be great. Researchers have advocated for a relational perspective to mood disorder treatment, and several promising treatments have been developed. However, few rigorous evaluations have been conducted within the Veterans Affairs (VA) system. Multifamily group therapy, an evidence-based practice for people living with schizophrenia, has recently been adapted for other psychological disorders with promising results. This report describes the first published evaluation of this treatment modality in the VA system for veterans living with mood disorders. 101 male veterans (74 with major depression and 27 with bipolar disorder) and their family members participated in REACH (Reaching out to Educate and Assist Caring, Healthy Families), a 9-month, manualized, multi-family group treatment, intervention adapted from McFarlane's original multi-family group model. Participants completed self-report questionnaires at four time points across the course of the treatment, and service utilization data for veterans were obtained from VA databases. Both veterans and family members showed improvements in their knowledge about mood disorders, understanding of positive strategies for dealing with situations commonly confronted in mood disorders, and family coping strategies. Veterans also evidenced improvement in family communication and problem-solving behaviors, empowerment, perceived social support, psychiatric symptoms, and overall quality of life. The REACH intervention holds promise as a feasible, acceptable, and effective treatment for veterans living with mood disorders and their families. Further study is warranted.

Objective This study compared the attitudes of mental health and primary care providers toward persons with schizophrenia at 5 Veterans Affairs (VA) facilities. Method This study utilized a cross-sectional anonymous survey, including clinical vignettes describing identical patient scenarios for a hypothetical patient with and without schizophrenia, to examine the differences in attitudes of primary care and mental health providers. The survey was distributed in 3 waves from August 2011 to April 2012. Participants included 351 VA providers from 5 VA medical centers, including 205 mental health providers (psychiatrists, psychologists, and mental health nurses) and 146 primary care providers (nurses and physicians). Providers' attitudes were assessed on 3 domains, including social distance, stereotyping, and attribution of mental illness. Results Primary care providers had significantly more negative attitudes toward the vignette patient with schizophrenia compared with the patient without schizophrenia on 2 of 3 attitude measures (stereotyping and attribution of mental illness); however, this difference was not observed for mental health providers on the 2 measures. Conclusions and Implication for Practice: Primary care providers' negative attitudes toward individuals with schizophrenia represent a potential target for interventions to reduce disparities in care for individuals with schizophrenia.

AimsTo investigate the prevalence and incidence of presbyopia in an urban Chinese population.Methods1817 subjects aged ≥35 years were identified by random cluster sampling in Yuexiu District, Guangzhou, China, at baseline in 2008, and all were invited for the follow-up examination in 2014. Distance and near visual acuity (VA) tests, as well as non-cycloplegic automated refraction were performed at each examination as per standardised protocol. Participants with presenting near VA ≤20/40 were further tested with add power at a standard distance of 40 cm to obtain their best-corrected near VA. Functional presbyopia was defined as near VA under presenting distance refraction correction of ResultsA total of 1191 (83.5% of the 2014 follow-up) participants were included in the current analysis with a mean (SD) age of 50.4 (9.7) years, and 52.9% were female. Prevalence of functional presbyopia at baseline was 25.2% (95% CI 21.5 to 28.9) and the 6-year incidence was 42.8% (95% CI 39.4 to 50.1). Older and more hyperopic subjects had both higher prevalence and incidence of presbyopia (PConclusionsPrevalence of functional presbyopia in urban China is relatively lower along with a higher PCC compared with previous population-based rural cohorts. We identified a high presbyopia incidence, and further studies are needed to understand longitudinal presbyopia progression as well as the urban–rural gap in presbyopia to throw light on future strategic planning.

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran's Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one's previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

Chronic administration of drugs of abuse leads to a dopamine deficient state in the mesolimbic system, causing dysphoria in abstinence and contributing to craving and return to use. Recent functional imaging studies have shown that listening to personally pleasing music activates the mesolimbic reward system in a fashion similar to drugs of abuse. It has been proposed that such activation could ameliorate the dysphoria and craving of the hypodopaminergic state. The present study sought to evaluate the efficacy of listening to personally pleasing or moving music on reducing craving in abstinent alcoholics using a single-blind, within-subject randomized block design, with three randomly determined presentations of each condition. Twelve participants with Alcohol Use Disorder on a residential substance rehabilitation unit reported their level of craving with a Visual Analog Scale before and after listening to either the participant-selected song or white noise. Using a mixed model to analyze the crossover design, the music intervention was found to have a statistically significant advantage in craving reduction compared to the noise control. Our results indicate that personally pleasing music might have a role in augmenting substance use disorder treatment via craving reduction. Further study is warranted to elucidate factors which predict the most robust response from this intervention.

PurposeTo provide a self-adaptive deep learning (DL) method to automatically detect the eye laterality based on fundus images.MethodsA total of 18394 fundus images with real-world eye laterality labels were used for model development and internal validation. A separate dataset of 2000 fundus images with eye laterality labeled manually was used for external validation. A DL model was developed based on a fine-tuned Inception-V3 network with self-adaptive strategy. The area under receiver operator characteristic curve (AUC) with sensitivity and specificity and confusion matrix were applied to assess the model performance. The class activation map (CAM) was used for model visualization.ResultsIn the external validation (N = 2000, 50% labeled as left eye), the AUC of the DL model for overall eye laterality detection was 0.995 (95% CI, 0.993-0.997) with an accuracy of 99.13%. Specifically for left eye detection, the sensitivity was 99.00% (95% CI, 98.11%-99.49%) and the specificity was 99.10% (95% CI, 98.23%-99.56%). Nineteen images were wrongly classified as compared to the human labels: 12 were due to human wrong labelling, while 7 were due to poor image quality. The CAM showed that the region of interest for eye laterality detection was mainly the optic disc and surrounding areas.ConclusionWe proposed a self-adaptive DL method with a high performance in detecting eye laterality based on fundus images. Results of our findings were based on real world labels and thus had practical significance in clinical settings.

We investigated possible associations between pain frequency and the 5 most common substance use disorders: alcohol abuse/dependence, cocaine abuse/dependence, methamphetamine abuse/dependence, opioid abuse/dependence, and marijuana abuse/dependence.We used data from the Rural Stimulant Study, a longitudinal (7 waves), observational study of at-risk stimulant users (cocaine and methamphetamine) in Arkansas and Kentucky (n=462). In fixed-effects logistic regression models, we regressed our measures of substance use disorders on the number of days with pain in the past 30 days and depression severity.Time periods when individuals had 1 to 15 days [odds ratio (OR)=1.85, P0.001] or 16+ days (OR=2.18, P0.001) with pain in the past 30 days were more likely to have a diagnosis of alcohol abuse/dependence, compared with time periods when individuals had no days with pain. Compared with time periods when individuals had no pain days in the past 30 days, time periods when individuals had 16+ pain days were more likely to have a diagnosis of opioid abuse/dependence (OR=3.32, P=0.02). Number of days with pain was not significantly associated with other substance use disorders.Pain frequency seems to be associated with an increased risk for alcohol abuse/dependence and opioid abuse/dependence in this population, and the magnitude of the association is medium to large. Further research is needed to investigate this in more representative populations and to determine causal relationships.

To investigate predisaster mental illness as a risk factor of poor postdisaster mental health outcomes, veterans with (n = 249) and without (n = 250) preexisting mental illness residing in the Gulf Coast during Hurricane Katrina were surveyed after Katrina and screened for posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder, and panic. Logistic regression examined the association between preexisting mental disorders and positive screens after the hurricane, adjusting for demographics and exposure to hurricane-related stressors. The odds of screening positive for any new mental disorder were 6.8 times greater for those with preexisting mental illness compared with those without preexisting mental illness. Among those with preexisting PTSD, the odds of screening positive for any new mental illness were 11.9 times greater; among those with schizophrenia, 9.1 times greater; and among those with affective disorders, 4.4 times greater. Persons with preexisting mental illnesses, particularly PTSD, should be considered a high-risk group for poor outcomes after a disaster.

Purpose To study age-related changes of intraocular pressure (IOP) and assess the cohort effect in both cross-sectional and longitudinal settings among elderly Chinese adults. Methods Participants were enrolled from the Lingtou Eye Cohort Study with Chinese government officials aged 40 years and older at baseline and received physical check-up and ocular examinations from 2010 to 2012. IOP was measured using a non-contact tonometer according to standardized protocols, as well as systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI). Participants who had attended IOP measurements in both 2010 and 2012 were included in this study. Cross-sectional association of IOP with age was assessed using multivariate liner regression analyses and based on the data of 2010. Longitudinal changes in IOP were assessed by paired t-test. Results A total of 3372 subjects were enrolled in the current analysis (2010 mean [SD] age, 61.9 [7.1] years; 60.2% men). The mean IOP in 2010 was 15.4±2.3 mmHg for women and 15.2±2.3 mmHg for men with an intersex difference (P = 0.029). Cross-sectional analysis showed that IOP was negatively associated with age (P = 0.003, β = -0.033 for women and P

Only a fraction of individuals with alcohol use disorders (AUDs) receive any AUD treatment during a given year. If a substantial proportion of individuals with unmet need for AUD treatment are receiving mental health treatment, accessibility of AUD treatment could potentially be improved by implementing strategies to ensure that individuals receiving mental health care are referred to the AUD sector or by increasing rates of AUD treatment in individuals receiving mental health treatment.We assessed patterns and predictors of mental health treatment and AUD treatment among individuals with 12-month AUDs, using secondary data analyses from two national surveys, the National Survey on Drug Use and Health (NSDUH; n = 4,545 individuals with AUDs) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 3,327 individuals with AUDs).In both NSDUH and NESARC, 8% of individuals with AUDs reported past-year AUD treatment. Among individuals with AUDs, mental health treatment was more common than AUD treatment, with 20% of NSDUH respondents and 11% of NESARC respondents reporting receiving mental health treatment. Greater mental health morbidity increased the odds of mental health treatment, and AUD severity increased the odds of AUD treatment. Mental health morbidity also increased the odds of AUD treatment, mainly by increasing the odds of receiving the category of both AUD and mental health treatment.Because individuals with AUDs are more likely to receive mental health treatment than AUD treatment, a key opportunity to improve the overall accessibility of treatment for AUDs may be to focus on improving AUD treatment among individuals receiving mental health treatment.

Background: Identifying individuals at risk for mental health problems after a disaster often involves assessing potentially traumatic exposures inherent to the disaster. Survivors of disasters also may have been exposed, both before and during the event, to trauma not directly related to the disaster. A substantial literature suggests exposure to interpersonal violence may have more severe negative outcomes than exposure to non-violent events; however, it is unclear whether violent vs nonviolent exposures before and during a disaster have differential effects on postdisaster psychological functioning.Methods: We examined the associations of violent and nonviolent exposures before and during Hurricane Katrina with postdisaster psychological functioning in a sample of male military veterans.Results: Violent and nonviolent exposures post-Hurricane Katrina as well as pre-Katrina violent exposures were significantly associated with symptoms of posttraumatic stress disorder, panic, and generalized anxiety disorder more than 2 years after the storm. Moreover, veterans who reported violent exposures pre-Katrina were more than 4 times more likely to have reexperienced interpersonal violence during Katrina than those who did not report such exposures.Conclusions: Results suggest assessing disaster-specific experiences in addition to predisaster interpersonal violence may be important for identifying and triaging individuals at risk for postdisaster mental health problems.(Disaster Med Public Health Preparedness. 2011;5:S227-S234)

Summary Background Acute respiratory distress syndrome (ARDS) is the inflammatory disorder of the lung most commonly caused by sepsis. It was hypothesized that treating the lung with penehyclidine hydrochloride (PHC), a new type of hyoscyamus drug, early in the development of sepsis could diminish the lung dysfunction. Material/Methods Sprague-Dawley rats were divided into 4 groups: 1) a control group; 2) a sham-operated group; 3) a cecal ligation and puncture (CLP) group; 4) a PHC-treated group. One hour after CLP surgery, rats were either untreated or treated with PHC via intraperitoneal injection. Lung wet/dry weight ratio, bronchoalveolar lavage fluid (BALF), serum tumor necrosis factor (TNF-α), interleukin 6 (IL-6), interleukin 10 (IL-10), total nitrite/nitrate (NOx), superoxide dismutase (SOD), malondialdehyde (MDA) in lung tissues, and pulmonary functions were examined 24 hour after surgery. Another 60 rats were randomly assigned to 4 equal groups to observe survival status 96 hours after surgery. Results Treatment of PHC markedly decreased TNF-α, IL-6, NOx, SOD, MDA content, protein concentration in BALF, and lung wet/dry weight ratio and enhanced SOD activity (p

Objective: Acute renal failure (ARF) is one of the most common causes of death in patients with severe acute pancreatitis (SAP). Here, we aimed to investigate the risk factors of ARF in patients with SAP, assess the prognosis of patients with SAP and ARF, and seek potential measures to prevent ARF. Method: A cross-sectional study was performed to analyze the data from patients with SAP. Both univariate and multivariate logistic regression analyses were performed, including 15 indices such as age, history of renal disease, Acute Physiology and Chronic Health Evaluation II scores, hypoxemia, abdominal compartment syndrome (ACS), and others. Univariate analysis was also used to compare the prognosis between the groups of patients with SAP with and without ARF. Results: There was a significant difference in age, history of renal disease, Acute Physiology and Chronic Health Evaluation II scores, hypoxemia, and ACS between the groups with and without ARF. Patients with SAP and ARF had significantly longer average length of stay and intensive care unit length of stay and higher infection rate of the pancreas and mortality rate. Conclusion: The significant risk factors for ARF in patients with SAP include history of renal disease, hypoxemia, and ACS. Measures that can prevent ARF include homeostasis maintenance, adequate perfusion of the kidneys, adequate oxygenation, and abdominal decompression to avoid ACS.

Substance use is associated with poor mental health, but little is known regarding how use of multiple substances is associated with mental health, particularly longitudinally, in community studies. This article examines this issue in a large (N = 710), natural-history study of rural stimulant (cocaine and/or methamphetamine) users in three states.Respondent-driven sampling recruited recent (past-30-day) stimulant users in three counties each in Arkansas, Kentucky, and Ohio. Participants were interviewed every 6 months for 3 years. Mental health was measured by the Brief Symptom Inventory, and prior 6 months' substance use was measured for 17 possible substances. Data analysis used generalized estimating equations for longitudinal data with the Global Severity Index of the Brief Symptom Inventory as the dependent variable at each interview and substance use as predictor variables measured by number of substances used in the past 6 months and, separately, the 17 individual substances, adjusting for use of substance-use treatment, demographics, and recruitment site.On average, both Global Severity Index score and use of many substances declined over the course of study. Global Severity Index score was significantly associated with (a) greater number of substances used in the past 6 months (p.0001) and (b) use of crack cocaine, methamphetamine, and nonprescription use of prescription painkillers and tranquilizers.Multiple and specific substances appear to incrementally increase psychological distress. Users of cocaine and methamphetamine are present in rural areas; these associations with poor psychological health raise concerns regarding availability of local treatment services for individuals with mental-health problems, as well as substance abuse.

Early initiation of substance use appears to be an alarming trend among rural minorities. This study focuses on 18- to 21-year-old African American stimulant users in the Arkansas Mississippi Delta. Most participants had no high school diploma and were unemployed; 74.5% had already been arrested. Substance use was initiated early and nearly all of the men and three-quarters of the women already met criteria for lifetime abuse or dependence. Only 18% reported that they had ever received substance abuse treatment. The results suggest that substance use interventions in rural communities will require multi-faceted strategies addressing economic, educational and healthcare disparities.

Substance abuse is a chronic, relapsing condition, yet some individuals over time seem to cease use for factors that are largely unclear. A life threatening episode of cocaine-associated chest pain requiring an emergency department (ED) visit may influence subsequent use. A consecutive cohort (n = 219) of patients who presented to a large, urban ED with cocaine-associated chest pain was interviewed at baseline, three months, six months, and 12 months to evaluate longitudinal rates of subsequent drug use. Overall, there was a significant decrease in cocaine use over time (baseline = 100.0%, three months = 56.5%, six months = 54.2%, and 12 months = 51.7%, p < .05 for baseline versus each follow-up interval). Findings suggest that substance use declines following an ED visit for cocaine-related chest pain. However, about half of the subjects were still using cocaine one year later. Future studies examining the potential impact of brief interventions or case management to intervene with this not-in-treatment ED population are warranted.