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This paper describes a scoping review of China's academic resource databases, relevant official websites, news reports and public accounts spanning a period from the end of 2019 to the end of 2022, to investigate the challenges in scientific integrity and ethical soundness of research conducted during and immediately after the COVID-19 pandemic in China. By conducting the scoping review with keywords related to the research questions in Chinese, relevant data were extracted and classified into four categories: challenges in research, challenges in ethics review, challenges in publishing academic work, and research ethics guidelines during and after the pandemic. The paper points out that problematic studies and findings increased with the escalation in medical research projects during the pandemic in China. The situation faced by researchers was more difficult than before the pandemic. The mode of informed consent, and ethics review and oversight systems also underwent changes. In addition, Traditional Chinese Medicine as an alternative medical treatment for COVID-19, attracted attention from the research community and became a topic of discussion. We conclude that the various challenges and concerns identified indicate a need for a proper and timely response system be formulated in preparation for possible future occurrences of new pandemics or other critical situations. [ABSTRACT FROM AUTHOR]

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Background: COVID-19 has started to spread within China since the end of December 2019. As a special population, the pregnant and delivery women maybe influenced both in physical and psychological aspects. The meta-analysis was conducted about mental health in pregnant and delivery women.Methods: We searched both MEDLINE, EMBASE, Cochrane Library in English and CBM, CNKI, WANFANG and CSSCI in Chinese to find literature from December 2019 to 31 July 2020 related to COVID-19 and mental health in patient with pregnancy and delivery, among which results such as comments, letters, reviews and case reports were excluded. The prevalence of anxiety and depression in the population was synthesized and discussed.Results: A total of 11,187 subjects were included in 15 studies. Random effect model is used to account for the data by Revman 5.2. The results showed that the prevalence of depression was 30% (95% CI: 0.23-0.37), the prevalence of anxiety was 34% (95% CI: 0.26-0.43) and prevalence of both anxiety and depression was 18% (95% CI: 0.09-0.29). The prevalence of anxiety (OR = 2.15, 95% CI: 1.39-3.31, Z = 3.47, p=.0005), depression (OR = 1.95, 95% CI: 1.07-3.56, Z = 2.19, p=.03) were higher than that of controls. Significant heterogeneity was detected across studies regarding these prevalence estimates. Subgroup analysis was taken according to assessment tools, and sensitivity analysis was done to explore the sources of heterogeneity.Conclusions: The higher prevalence of depression, anxiety, both depression and anxiety in women with pregnancy and delivery during COVID-19 pandemic although the significant heterogeneity detected in studies. We must interpret the results with caution and also put attention to this result. As the epidemic is ongoing, it is vital to set up a comprehensive crisis prevention system. [ABSTRACT FROM AUTHOR]

Background: Pompe disease (PD) is a rare inherited disorder caused by the deficiency of acid-α glucosidase, which leads to the impairment of organ and tissue functions and causes disabilities. As the first national survey on patients with late-onset PD (LOPD) in China, this study investigated the quality of life (QOL) of adult patients with LOPD in China and explored its contributors.Methods: Data were derived from a nation-based, cross-sectional, self-response survey on rare diseases (RDs) in early 2018. Answers from 68 adult Chinese patients with LOPD were used for data analysis. QOL was measured using the World Health Organization Quality of Life: Brief Version. Covariates included age, gender, education, employment, reliance on assistive devices, medication history, social support, and disease economic burden. Data were analyzed using linear regression in R.Results: For adult patients with LOPD, the average scores and standard deviations (SD) of the four dimensions of QOL were physical health = 33.77 (SD = 18.28), psychological health = 43.81 (SD = 21.70), environmental health = 39.43 (SD = 16.93), and social relationship = 46.20 (SD = 19.76); the scoring for each dimension was evaluated on a scale of 0 to 100. At the significance level of p < 0.05, with increasing age, the patients experienced a significant decrease in physical health QOL (β = - 0.75) and environmental health QOL (β = - 0.79). Those who relied heavily on assistive devices had lower perceived physical health (β = - 17.8), psychological health (β = - 22.76), environmental health (β = - 17.8), and social relationships (β = - 22.12) than those who did not. A one-unit increase in the amount of social support, as a form of social interaction, led to a significant increase in physical health (β = 0.28), psychological health (β = 0.71), environmental health (β = 0.72), and social relationships (β = 0.70).Conclusion: Adult Chinese patients with LOPD had a lower physical health and QOL compared to their counterparts with other RDs. Being employed was found to affect the QOL of adult Chinese patients with LOPD in almost all dimensions. Encouraging adult Chinese patients with LOPD to be socially active and help them become more involved in social life might improve their QOL. [ABSTRACT FROM AUTHOR]

Patient advocacy and media coverage are important strategies for changing health policies. China is no exception. Through 31 interviews and content analysis of 1,136 news stories related to hepatitis B, this study revealed how members of Chinese health advocacy groups strategically built a coalition with the news media, actively played the role of 'policy entrepreneurs', and successfully affected the framing of hepatitis B. As a result, China's grassroots civil societies not only successfully attracted public attention to the previously ignored problem of discrimination against people affected by hepatitis B but also impacted on the state's rewriting of public policies on this disease. [ABSTRACT FROM AUTHOR]

A travel or transport path reflects the settlement pattern and the spread of civilization. Travel simulations of the pre-Qin period of the Central Plains of China can deepen our understanding of the origin and development of Chinese civilization. Here, based on the idea of swarm intelligence, an ant colony optimization algorithm based on gradient descent and variable-neighborhood search (GD-VNSACO) methods is proposed to simulate the travel routes of ancestors. We simulate the process of humans gradually exploring the surrounding space and obtaining experience and inspiration in four cultural periods from 7 to 2.7 ka B.P. (including the Yangshao Period, Miaodigou II Period, Longshan Period and Xia Shang and Zhou Period). The GD-VNSACO algorithm is suitable for studying settlement travel because of its improved search ability and convergence speed based on local and overall optimization. We conclude that in the four periods, the high-density routes of transport were concentrated along the Fen River, forming a main line from north to south. Over time, high-density areas of transport and communication among settlements, as well as the transport scope, expanded. However, there was an abnormality in the Miaodigou II Period, which was mainly caused by the climate becoming dryer and colder. [ABSTRACT FROM AUTHOR]

Purpose: The association of chronic lymphocytic leukemia (CLL) with health-related quality of life (HRQoL) is rarely studied globally. This study evaluated the psychometric properties of the EORTC-Chronic Lymphocytic Leukaemia (CLL17 [phase III]) module, a newly developed assessment on CLL patients' HRQoL, among Chinese CLL patients.Methods: The Chinese CLL17, comprised of three subscales (symptom burden [SB], physical condition [PC] and worries/fears [WF]), was provided by the developer team through EORTC. A cross-sectional online survey was conducted to collect data. The classical traditional theory (CTT) and the item response theory (IRT) were used to evaluate the psychometric properties of CLL17. Internal consistency reliability was determined by the Cronbach's alpha and item-total correlation. Dimensionality was verified through confirmatory factor analysis (CFA). Convergent validity was also assessed. The generalized partial credit model was used for the IRT. The difficulty, discrimination, item fit, and differential item functioning (DIF) were calculated to assess the instrument's psychometric properties.Results: In all, 318 patients, aged between 26 and 82 years, completed the questionnaire. A good level of internal reliability was achieved (Cronbach's alpha = 0.92). The item-total correlation coefficient ranged from 0.46 to 0.72. There was a mid-to-high correlation between CLL17 and domains of EQ-5D and QLQ-C30. The IRT model showed a satisfactory homogeneity, item fit and good discrimination of items, except for item 4, 6 and 16 (< 1.0). low information provided by item 16 and 17. SB and PC provided more information with theta > 0, whereas WF provided more information with theta < 0. Item 17 perform inconsistently for respondents from different age groups (DIF).Conclusion: The EORTC-CLL17 Chinese version shows acceptable reliability and validity, making it a valuable instrument to evaluate the impact on the HRQoL of Chinese CLL patients. [ABSTRACT FROM AUTHOR]

Importance Myopia is a major public health concern worldwide, while outdoor time is indicated to be protective against the onset of myopia. Background: To describe the methodology and baseline data of the Shanghai Time Outside to Reduce Myopia (STORM) trial. Design A 2‐year, school‐based, prospective, cluster randomized trial. Participants: Children from grade I and II classes of 24 schools from eight districts in Shanghai, China, were randomized to either a control group, a test group I (40‐min outdoor time/day) or test group II (80‐min outdoor time/day). Methods: At baseline and annual intervals, cycloplegic autorefraction and axial length measurement will be performed. Time outdoors and light exposure will be monitored via parent/carer questionnaires and a wearable device. Main Outcome Measures: Spherical equivalent, prevalence of myopia and time outdoors in each group. Results: A total of 6295 eligible children (age 7.2 ± 0.7 y [6‐9 y]) were randomized to control (n = 2037), test group I (n = 2329) and test group II (n = 1929). At baseline, spherical equivalent was +0.98 ± 1.02D, +1.02 ± 1.02D and +1.00 ± 0.99D (P = 0.708), myopia prevalence was 8.9, 7.7 and 7.8% (P = 0.270) and time outdoors was 58.5 ± 35.8, 59.8 ± 34.7 and 58.5 ± 35.3 min/d (P = 0.886) for control, test groups I and II, respectively. Conclusions and Relevance: Myopia prevalence was high at nearly 8 to 9% in school children aged 7 years in Shanghai, China. The current trial will help evaluate if increased time outdoors has a role to play in reducing the incidence of myopia and/or slow the progression of myopia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this project is to explore the changes in and factors associated with asymmetry between the superior and inferior hemiretina in children with different refractive levels. Materials and Methods: A total of 2964 children from 12 primary and middle schools in Shanghai, China, were included. The mean thickness of the GCL+ layer (ganglion cell layer+ inner plexiform layer), the GCC layer (ganglion cell complex, a combination of the retinal nerve fiber layer and the GCL+ layer), and the neural retina was measured according to the sectors defined by the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid with swept-source optical coherence tomography. The asymmetry index (AI), calculated via the formula AI = |log10 (superior/inferior hemiretinal layer thickness) |, was used to assess the asymmetry of each retinal layer. Results: The mean age of the children was 11.67 (3.45) years old. The AIs of all retinal layers were larger in myopes than in hyperopes and emmetropes in the perifoveal region (all p < 0.001), and the AIs became even larger in the GCL+ layer and neural retina in children with a higher degree of myopia. However, no statistical differences were observed between various refractive groups in the parafoveal region. Regression analyses indicated that with increasing myopia, the asymmetry of retinal layers increased in the perifoveal region (all p < 0.001) and slightly decreased in the parafoveal region (all p < 0.05). Conclusions and relevance: The vertical asymmetry of retinal layers increased in the perifoveal region in myopic children, and the change in asymmetry was more obvious in the GCL+ layer and neural retina than in the GCC layer. [ABSTRACT FROM AUTHOR]

Abstract: Importance: Nearly half of children suffering vision impairment reside in China with myopia accounting for the vast majority. Background: To describe the design and methodology of the Shanghai Child and Adolescent Large‐scale Eye Study (SCALE). Design: The SCALE was a city wide, school‐based, prospective survey. Participants: Children and adolescents aged 4–14 years from kindergarten (middle and senior), primary schools and junior high schools of all 17 districts and counties of the city of Shanghai, China were examined in 2012–2013. Methods: Each enrolled child underwent vision assessment (distance visual acuity; uncorrected and with corrective device if worn) and their parent/carer completed a questionnaire designed to elicit risk factors associated with myopia. Additionally, non‐cycloplegic autorefraction and ocular axial length was measured in a subset of the larger sample. Main Outcome Measures: Prevalence and the associated factors of vision impairment, myopia and high myopia in Shanghai. Results: In 2012–2013, a total of 910 245 of the eligible 1 196 763 children and adolescents identified from census (76%, mean age 9.0 ± 2.7 years [4–14 years]) were enrolled with visual acuity screened in the city of Shanghai. Of these, 610 952 children (67% of the entire sample) underwent non‐cycloplegic autorefraction and 219 188 (24% of the entire sample) had both non‐cycloplegic autorefraction and axial length measurements. Conclusions and Relevance: The study results will provide insights on the burden of vision impairment, myopia and high myopia in children and adolescents in a metropolitan area of China, and contribute to the policies and strategies to address and limit the burden. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the refraction and ocular biometry characteristics and to examine the prevalence of refractive errors in preschool children aged 3 to 6 years in Shanghai, China. Methods. A school-based cross-sectional study was conducted in Jiading and Xuhui District, Shanghai, in 2013. We randomly selected 7 kindergartens in Jiading District and 10 kindergartens in Xuhui District, with a probability proportionate to size. The children underwent comprehensive eye examinations, including cycloplegic refraction and biometric measurements. Myopia, hyperopia, astigmatism were defined as spherical equivalent (SE) ≤ −0.50 D, SE ≥ +2.00 D, and cylindrical diopters ≤ −1.00 D. Results. The mean SE for 3- to 6-year-old children was +1.20 D (standard deviation [SD] 1.05), and the mean axial length (AL) was 22.29 mm (SD 0.73). The overall prevalence of myopia and astigmatism was 3.7% and 18.3%, respectively. No difference in prevalence of astigmatism was found across age groups. There was a statistically significant association between lower cylindrical diopters and higher spherical diopters (Spearman’s correlation: −0.21, P<0.001). Conclusion. Chinese children aged 3 to 6 years in the Shanghai area were mostly mildly hyperopic, with a low prevalence of myopia. Refractive astigmatism for children may be relatively stable throughout the preschool stage. Astigmatism was significantly associated with refractive error. [ABSTRACT FROM AUTHOR]

Background: In 2010, there were ~ 36 million migrant children under 18 y old in China. This study compared patterns of myopia prevalence and progression between migrant and resident children.Methods: Eight hundred forty-two migrant children from 2 migrant schools and 1081 from 2 local schools in Baoshan District, Shanghai, were randomly chosen. Baseline measurements were taken on children in grades one through four, and children in grades one and two were followed for 2 y. The children underwent comprehensive ophthalmic examinations, including cycloplegic refraction and axial length. The average time per week spent on homework and outdoor activities were investigated.Results: Migrant children in grades one and two showed a lower myopia prevalence than resident children; however, from grades three to four, the prevalence accelerated and exceeded that of residents. In the follow-up, the myopia incidence did not significantly change from grades one to two in resident children but was significantly higher in grade two in migrant children. Correspondingly, for migrant children, increased progression of refraction and axial length was observed; however, it decreased in resident children. The average time spent on homework increased from grades two to three in parallel with the acceleration of myopia prevalence for migrant children; however, the time spent outdoors did not correspondingly change.Conclusion: The patterns of myopia prevalence and progression are different between migrant and non-migrant children. The acceleration of myopia in migrant children might be a result of a change in their environment, such as intensive education pressure. [ABSTRACT FROM AUTHOR]

We investigated the prevalence of clinical trachoma in 154,265 children aged 6 to 16 years in 206 Shanghai migrant schools. Clean water availability in school, each child’s facial cleanliness, eyelids, corneas, and the presenting distance visual acuities were examined. Trachoma was clinically diagnosed in accordance with the World Health Organization simplified classification. Eyes diagnosed with trachoma were swabbed to test for ocular Chlamydia trachomatis infections (OCTI) with a rapid latex immunochromatographic test. Among 153,977 students, no blindness was found related to trachoma. Trachoma was diagnosed in 8029 children (5.2%). In 87 schools clinical trachoma prevalence was higher than 5%. OCTI was confirmed in 2073 of 6823 trachoma diagnosed children (30.4%). Clinical trachoma prevalence was higher among females than males (p<0.001), but gender comparison showed no statistical difference in the prevalence of OCTI (p=0.077). Age and clinical trachoma (r=-0.014; p<0.001) or OCTI (r=-0.026; p=0.031) prevalence were negatively correlated. Clinical trachoma was different in different districts and counties (p<0.001). Trachoma warrants close attention in Shanghai migrant children because the condition remains endemic in some schools. [ABSTRACT FROM AUTHOR]

Based on ethnographic research on prenatal health care in China from 2005 to 2007, in this paper I show how ideas about potentiality have a tendency to increase anxieties about anomalous births that many believe can and should be prevented. Focusing on maternal serum screening (MSS), I examine how through local agencies and with the help of the market the state has developed a "quality-assurance regime" that recruits expectant mothers to take active measures of self-assurance. Under such circumstances, MSS is promoted as the safest and most economical and efficient method to predict the potential of the only child. In practice, however, as a screening test, the results of MSS only offer a probability, either "high risk" or "low risk." Facing such uncertainty, pregnant women question the doctors who conduct the tests and deliver the results that offer only vague information. At this point, the quality-assurance regime fails. [ABSTRACT FROM AUTHOR]

Background: Myasthenia gravis (MG), a chronic neuromuscular disorder, can adversely affect patients' health-related quality of life (HRQoL), especially in women. The study aimed to evaluate the difference in HRQoL of women and men MG patients and explore the factors that mediate the relationship between gender and HRQoL.Methods: A cross-sectional study was conducted among 1815 patients with MG in China. The revised 15-item MG quality of life scale (MG-QOL15r) was used to access patients' HRQoL in overall, physical, social and emotional domains. Socio-demographic information, diagnosis and treatment history, comorbidities, social support, active lifestyle and the MG activities of daily living scale (MG-ADL) were recorded and compared between women and men using the Student's t-test and Pearson's Chi-square test. Multivariable regression analyses were conducted to identify independent contributors to HRQoL, especially those affecting different gender.Results: On average, female patients with MG reported a lower MG-QOL15r score than the males (44.49 ± 29.10 vs 49.32 ± 29.18). The association between gender and patients' HRQoL interacted with the number of comorbidities across the overall, physical and social domains of patients. As the number of comorbidities increased, the scores of HRQoL decreased and it was faster among females than the males (p < 0.05). Moreover, unemployment, exacerbation of the disease, and active lifestyle contributed to the patients' HRQoL across all domains. Unemployment (β = - 4.99 [95%CI, - 7.80 to - 2.18], p < 0.001) and exacerbations (β = - 8.49 [95%CI, - 11.43 to - 5.54], p < 0.001) were correlated with poorer HRQoL; while an active lifestyle had a positive impact on HRQoL (β = 0.28 [95%CI, 0.16 to 0.40], p < 0.001).Conclusions: The results indicate that the HRQoL of women MG patients was lower than that of men. The relationship between gender and HRQoL is modulated by the number of comorbidities. Thus, to improve the HRQoL of women MG patients, symptomatic treatments might not be enough, their comorbid conditions should be considered as well. Additionally, employment status, MG exacerbations, and an active lifestyle have been found as determining factors of the patients' HRQoL, which suggests future interventions should cope with these factors to improve their quality of life. [ABSTRACT FROM AUTHOR]

The persimmon-red glazed wares, characterized by a reddish-brown appearance with high gloss, were one of the main varieties of glazes manufactured in Jian kilns (Fujian province, China) during the Song Dynasty. Densely packed dendritic ε-Fe 2 O 3 crystals in microns size composed of several branches were observed in the glazes surfaces of Jian persimmon-red wares. The branches, consisting of well-arranged rod-like crystals with offset around 110 or 220 nm, could serve as sub-micron mirrors to improve the glaze gloss. A number of Al and few Ti and Mn ions were detected to substitute Fe ions in ε-Fe 2 O 3 crystals. The Al substitution could play a dual role in ε-Fe 2 O 3 structure: (1) stabilizes the structure through increasing of cationic disorder and (2) makes the appearance less dark, which could account for the nice persimmon-red appearance of Jian wares. Besides, zircon, quartz, hematite, jacobsite and mullite were also observed in the glaze surfaces. • Dendritic ε-Fe 2 O 3 crystals in microns size composed of several branches were observed in the glazes surfaces of Jian persimmon-red wares. • The branches consisting of well-arranged rod-like crystals with offset ~110 or 220 nm could serve as sub-micron mirrors to improve glaze gloss. • Al substitutions in ε-Fe 2 O 3 crystals could play a dual role of acting as stabilizers to increase cationic disorder and making appearance less dark. • A few impurity crystals including zircon, quartz, hematite, jacobsite and mullite were detected in the glazes surfaces. [ABSTRACT FROM AUTHOR]

Background: Our study aimed to investigate the ocular surface health of Shanghai University students.Methods: This is a cross-sectional study carried out among freshmen and sophomores on the main campus of Shanghai University. Questionnaires including the widely-used ocular surface disease index (OSDI) and the Zung Self-rating Anxiety Scale (SAS) were completed first, and then ocular examinations were conducted regarding height & weight, blood pressure and heart rate, optometry, intraocular pressure exam, vision and subjective refraction, Aladdin, Macular pigment density measurement, tear test, anterior segment examination, fundus photography, ophthalmologist check, TOPCON OCT check, and Collin's fundus blood test.Results: Totally 901 students were involved in our five-day study. The prevalence of myopia was 92% (the spherical equivalent refraction (SER) < - 0.50 D), and that of high myopia was 23% (SER < - 6.0D). The prevalence of dry eye disease (DED) was 10%. The corneal epithelial loss rate (corneal fluorescein staining > 1) was 10%, and corneal sensation decline rate (≤ 30 mm) was 12%. 4.5% of subjects (n = 40) had moderate or severe anxiety, 78% were mild and a small portion (17.5%) didn't have anxiety at all. No statistical significant association was found between anxiety with DED, fluorescein staining or with corneal sensation (all p > 0.05). However, subjects with DED had more symptoms of anxiety. Results also showed that students who kept eye strain for a long time were more inclined to have DED (12.5%: 6.9%, p = 0.0407, 95% CI); those who watched mobile phones and/or computers for over eight hours daily were more vulnerable to DED and fluorescein staining than others (14.1%: 8.6%, p = 0.0129; 13.0%: 8.3%, p = 0.0233, 95% CI).Conclusions: Keeping eye strain or near work for a long time is associated with DED, while students with DED tend to encounter anxiety symptoms. The prevalence of myopia in Chinese university students is still high. We consider it necessary to provide education to university students about the good eye-using habits, and to diagnose anxiety for student patients with DED. [ABSTRACT FROM AUTHOR]

Background: This study was performed to evaluate the prevalence and clinical characteristics of dry eye disease (DED) in community-based type 2 diabetic patients and to identify the associated factors related with DED.Methods: A total of 1360 type 2 diabetic patients in the Beixinjing community were randomly selected. All participants were given a questionnaire that assessed basic information and subjective symptoms.DED was diagnosed using the revised Japanese DED diagnostic criteria. All subjects underwent a routine ophthalmic examination, corneal sensitivity test, tear film break-up time(BUT) test, Schirmer I test, fluorescein and lissamine green staining(FL) and fundus photography. Diabetic retinopathy (DR) was graded according to the International severity scale of diabetic retinopathy and diabetic macular edema.Results: Of the 1360 subjects, 238 (17.5%) were diagnosed with DED. There was a significant association between the presence of DED and higher blood glucose (P < 0.001, OR1.240) as well as higher levels of glycosylated hemoglobin HbA1c (P < 0.001, OR1.108). Corneal sensitivity was negatively correlated with the prevalence of DED (P = 0.02, OR0.973).Conclusions: The prevalence of DED in this community-based study was 17.5%, which was lower than that observed in hospital-based studies. Diabetic patients with poor metabolic control were more likely to present with DED. A dry eye examination should be added to the routine screening of diabetes. [ABSTRACT FROM AUTHOR]

Background: It was reported that lack of knowledge, less confidence of medical services, commute difficulties, and poor economic conditions would be the main barriers for cataract surgery practice. The influencing factors could have changed in cities with high developing speed. Shanghai is one of the biggest cities in China and the world. The purpose of the study was to explore the factors influencing cataract surgery practice in Shanghai.Methods: This was a population-based, cross-sectional study. A total of 2342 cataract patients older than 50 years old with cataract-induced visual impairment or who had undergone cataract surgery were recruited from rural and urban areas of Shanghai. Participants accepted a face-to-face structured questionnaire. Data were collected on patient demographics, education, work, income, health insurance, awareness about cataracts disease, treatment and related medical resources and deration policy, transportation and degree of satisfaction with hospitals.Results: There were 417 patients who had received cataract surgery, 404 of them supplied complete information in the questionnaire. More female subjects (64.6%) than male subjects (35.4%) accepted cataract surgery among the 404 patients. Of the patients with cataract history, 36.4% of surgery patients were equal or older than 80. More people with urban medical insurance received surgery (p = 0.036). Patients who received surgery were more satisfied with local medical service (p = 0.032). In urban area, Lower income and difficulties with commutes were related to a higher rate of surgery.Conclusions: Cataract patients with the following features were more inclined to receive surgery: female, old age, better awareness. In urban areas low income and difficult commutes did not represent barriers for cataract surgery, probably because of appropriate cataract surgery promotion policies recent years in Shanghai. In rural areas, better healthcare reimbursement policies would likely lead to a higher uptake of cataract surgery. Further cohort studies with more controls could supply stronger evidence for our viewpoint. [ABSTRACT FROM AUTHOR]

• Three commercial BSF colonies were identified in China. • Enterococcus and V agococcus are dominant genera in cold-tolerant BSFL bred at 16℃. • A series of gene pathways are associated with the development of cold tolerance. The larvae of black soldier fly (BSFL) convert organic waste into insect proteins used as feedstuff for livestock and aquaculture. BSFL production performance is considerably reduced during winter season. Herein, the intraspecific diversity of ten commercial BSF colonies collected in China was evaluated. The Bioforte colony was subjected to selective breeding at 12 °C and 16 °C to develop cold-tolerant BSF with improved production performance. After breeding for nine generations, the weight of larvae, survival rate, and the dry matter conversion rate significantly increased. Subsequently, intestinal microbiota in the cold-tolerant strain showed that bacteria belonging to Morganella , Dysgonomonas , Salmonella , Pseudochrobactrum , and Klebsiella genera were highly represented in the 12 °C bred, while those of Acinetobacte r, Pseudochrobactrum , Enterococcus , Comamonas , and Leucobacter genera were significantly represented in the 16 °C bred group. Metagenomic revealed that several animal probiotics of the Enterococcus and Vagococcus genera were greatly enriched in the gut of larvae bred at 16 °C. Moreover, bacterial metabolic pathways including carbohydrate, lipid, amino acids, and cofactors and vitamins, were significantly increased, while organismal systems and human diseases was decreased in the 16 °C bred group. Transcriptomic analysis revealed that the upregulated differentially expressed genes in the 16 °C bred groups mainly participated in Autophagy-animal, AMPK signaling pathway, mTOR signaling pathway, Wnt signaling pathway, FoxO signaling pathway, Hippo signaling pathway at day 34 under 16 °C conditions, suggesting their significant role in the survival of BSFL. Taken together, these results shed lights on the role of intestinal microflora and gene pathways in the adaptation of BSF larvae to cold stress. [ABSTRACT FROM AUTHOR]

Background: To investigate the prevalence and risk factors of undercorrected refractive error (URE) among people with diabetes in the Baoshan District of Shanghai, where data for undercorrected refractive error are limited.Methods: The study was a population-based survey of 649 persons (aged 60 years or older) with diabetes in Baoshan, Shanghai in 2009. One copy of the questionnaire was completed for each subject. Examinations included a standardized refraction and measurement of presenting and best-corrected visual acuity (BCVA), tonometry, slit lamp biomicroscopy, and fundus photography.Results: The calculated age-standardized prevalence rate of URE was 16.63% (95% confidence interval [CI] 13.76-19.49). For visual impairment subjects (presenting vision worse than 20/40 in the better eye), the prevalence of URE was up to 61.11%, and 75.93% of subjects could achieve visual acuity improvement by at least one line using appropriate spectacles. Under multiple logistic regression analysis, older age, female gender, non-farmer, increasing degree of myopia, lens opacities status, diabetic retinopathy (DR), body mass index (BMI) index lower than normal, and poor glycaemic control were associated with higher URE levels. Wearing distance eyeglasses was a protective factor for URE.Conclusion: The undercorrected refractive error in diabetic adults was high in Shanghai. Health education and regular refractive assessment are needed for diabetic adults. Persons with diabetes should be more aware that poor vision is often correctable, especially for those with risk factors. [ABSTRACT FROM AUTHOR]

Using the Surface waterproofing to solve moisture expansion which leads to the acceleration of surface weathering of sandstone relics is a hot topic. This study focuses on surface coating protection because of the special status of cultural relics. The fluorinated ZnO/SiO 2 nano-coating was applied on the sandstone matrix in this work. The loading of the fluorinated ZnO/SiO 2 in the nano-coating, the penetration depth of the nano-coating in the sandstone matrix, and the waterproofing effect of the sandstone surface were investigated within the limitation of the color difference systematically. The freeze-thaw cycles, light exposure, water absorption, and aging tests were carried out to evaluate the environmental durability of the nano-coating in a simulated humid environment of southwestern of China. All the tests meet the criteria for the heritage protection color difference. When the loading of fluorinated ZnO/SiO 2 nano-coating is 0.4%, the water contact angle (WCA) and oil contact angle (OCA) are significantly improved, which are larger than 160° and 140°, respectively. The WCA and OCA have little changed after freeze-thaw cycle for three weeks, and the WCA only decreases only 7% after 300 h UV aging treatment. This significantly enhanced stability is due to the good penetration depth of the fluorinated ZnO/SiO 2 nano-coating on the sandstone matrix. Moreover, the excellent air permeability is achieved as well to ensure substrate breathing. This work would provide a new idea for the long-term protection of sandstone heritage in practical environment. [ABSTRACT FROM AUTHOR]

Abstract As one of the world's oldest civilizations, China has a continuous history that extends for more than 5000 years. There are many important capital cities throughout China. However, little information is available in the literature about capital city sites using remote sensing because of its various geographical conditions. This paper designs new methodologies for detecting archaeological features in Northern and Southern China based on multi-source remotely sensed data. Based on various environmental factors, multitemporal images were interpreted to analyse an ancient city located in Southern China, while the integral of the Normalized Difference Vegetation Index (NDVI) time series and thermal infrared images were employed to detect the archaeological features in Northern China; these results were then cross-compared with each other. The results demonstrate that the use of integrated remote sensing technology can provide valuable information and indications of archaeological remains in ancient capital city sites in different geomorphological and vegetated environments in China. Our results also demonstrate that capital city sites can be detected using the proposed approach. [ABSTRACT FROM AUTHOR]

Primary batteries based on lithium metal anodes have been attracting increasing attention due to their high capacity and energy density, but the implementation high-current of battery still faces many challenges, such as low reaction rate of SOCl 2 and large impedance. Space-confined construction of nitrogen-rich cobalt porphyrin-derived nanoparticulates anchored on functional-activated carbon (NCA) composites were prepared by in situ solid phase synthesis as catalysts of carbon cathode to address these issues. On the molecular level, the π-π conjugate system is further enhanced by forming C–O–Co bond between the Co atoms of cobalt porphyrin derivatives and the oxygen-containing functional groups of functional-activated carbon. Significantly, the resulting NCA composites exhibit the longest high-current (above 25 mA/cm2) discharge time, up to 37 min, and the capacity is about 19.18 mAh, accounting for 88.5% of its total capacity. Meanwhile, the internal resistance of the battery catalyzed by the NCA composites (24.06 Ω) is 0.40 times lower than that without catalysts, and the reduction peak of cyclic voltammetry is the largest about 2.357 V, showing that the electrode with NCA composites has good catalytic activity. All this is due to the fact that the carrier activated carbon of the NCA composites reduces the internal resistance of the battery by regulating the porosity of the carbon cathode, and the loaded CoTAP nanoparticulates improve the reduction rate of SOCl 2. The eight diagrams of Zhouyi in China can well explain the relationship between components in composites. For NCA composites, the carrier AC-F and CoTAP nanoparticulates not only complement each other, but also limit each other. AC-F can increase the discharge time (DT) of the battery, but not the current. On the contrary, CoTAP can increase the discharge current (DC) but not the time. Therefore, the combination of the two to generate NCA composites can simultaneously improve the discharge time and current of the battery. Image 1 • Nitrogen-rich cobalt porphyrin-derived nanoparticulates were constructed on the activated carbon by space-confined strategy. • On the molecular level of NCA composites, the π-π conjugate system is further enhanced by forming C–O–Co bond. • The resulting NCA composites exhibit the longest high-current (above 25 mA/cm2) discharge time, up to 37 minutes. • The internal reaction mechanism of the Li/SOCl 2 battery with the NCA composites is constructed. [ABSTRACT FROM AUTHOR]

Elderly patients with lymphoproliferative diseases (LPD) are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we retrospectively described the clinical features and outcomes of the first time infection of Omicron SARS-CoV-2 in 364 elderly patients with lymphoma enrolled in Jiangsu Cooperative Lymphoma Group (JCLG) between November 2022 and April 2023 in China. Median age was 69 years (range 60-92). 54.4% (198/364) of patients were confirmed as severe and critical COVID-19 infection. In univariable analysis, Age > 70 years (OR 1.88, p = 0.003), with multiple comorbidities (OR 1.41, p = 0.005), aggressive lymphoma (OR 2.33, p < 0.001), active disease (progressive or relapsed/refractory, OR 2.02, p < 0.001), and active anti-lymphoma therapy (OR 1.90, p < 0.001) were associated with severe COVID-19. Multiple (three or more) lines of previous anti-lymphoma therapy (OR 3.84, p = 0.021) remained an adverse factor for severe COVID-19 in multivariable analysis. Moreover, CD20 antibody (Rituximab or Obinutuzumab)-based treatments within the last 6 months was associated with severe COVID-19 in the entire cohort (OR 3.42, p < 0.001). Continuous BTK inhibitors might be protective effect on the outcome of COVID-19 infection (OR 0.44, p = 0.043) in the indolent lymphoma cohort. Overall, 7.7% (28/364) of the patients ceased, multiple lines of previous anti-lymphoma therapy (OR 3.46, p = 0.016) remained an adverse factor for mortality., Competing Interests: Declarations. Ethical approval: This study was approved by the Ethics Committee of the Affiliated Hospital of Nantong University. Competing interests: The authors have declared that no competing interest exists., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This research aims to generate normative values of hyperopia reserve and refractive progression as effective tools to estimate the risk of myopia., Methods: A 1-year follow-up study was conducted among Chinese children and adolescents aged 3-16 years selected from schools and kinder gardens using cluster sampling. All participants underwent examinations including visual acuity, axial length and cycloplegic autorefraction (1% cyclopentolate). Percentiles of spherical equivalent (SE) were calculated using Lambda-Mu-Sigma (LMS) method. Age-specific refractive progression and hyperopia reserve were determined by backward calculation., Results: Of 3118 participants, 1702 (54.6%) were boys with a mean baseline age of 7.30 years. The 50th percentile of SE estimated by LMS decreased from 1.04 D at 3 years to -2.04 D at 16 years in boys, while from 1.29 D to -2.81 D in girls. The 1-year refractive progression of myopes (0.81 D) was greater than that of non-myopes (0.51 D). The normative value of hyperopia reserve was 2.64 (range: 2.40 D-2.88 D) at 3 years and -0.35 (range: -0.50 to -0.17) D at 16 years, with the maximum progression of 0.35 D at the age of 6 years., Conclusion: Age-specific normative values of hyperopia reserve and yearly myopic shift in children and adolescents aged 3-16 years were provided, helping identify and monitor myopia and giving prevention in advance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents' preference for this new pattern are unclear., Objective: This study aimed to compare the service quality and residents' preferences between facilitated self-service eye screening and traditional manual screening and to explore the relationships between the screening service's quality and residents' preferences., Methods: We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site comprised the control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological discomfort, safety, convenience, and trustworthiness. The secondary outcome was the participants' preferences. Differences in service quality and the participants' preferences between the 2 groups were compared using chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service's quality and residents' preference were conducted using generalized logit models., Results: A total of 358 residents enrolled; among them, 176 (49.16%) were included in the exposure group and the remaining 182 (50.84%) in the control group. Residents' basic characteristics were balanced between the 2 groups. There was no significant difference in service quality between the 2 groups (image quality pass rate: P=.79; average screening time: P=.57; no physiological discomfort rate: P=.92; safety rate: P=.78; convenience rate: P=.95; trustworthiness rate: P=.20). However, the proportion of participants who were willing to use the same technology for their next screening was significantly lower in the exposure group than in the control group (P<.001). Subgroup analyses suggest that distrust in the facilitated self-service eye screening might increase the probability of refusal to undergo screening (P=.02)., Conclusions: This study confirms that the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents' preferences for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must be cautious. We suggest that attention be paid to the residents' individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed., (©Senlin Lin, Yingyan Ma, Yanwei Jiang, Wenwen Li, Yajun Peng, Tao Yu, Yi Xu, Jianfeng Zhu, Lina Lu, Haidong Zou. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.04.2024.)

Purpose: To identify the relationship of macular outward scleral height (MOSH) with axial length (AL), macular choroidal thickness (ChT), peripapillary atrophy (PPA), and optic disc tilt in Chinese adults., Methods: In this cross-sectional study, 1088 right eyes of 1088 participants were enrolled and assigned into high myopia (HM) and non-HM groups. MOSH was measured in the nasal, temporal, superior, and inferior directions using swept-source optical coherence tomography images. The clinical characteristics of MOSH and the association of MOSH with AL, macular ChT, PPA, and tilt ratio were analysed., Results: The mean age of participants was 37.31 ± 18.93 years (range, 18-86 years), and the mean AL was 25.78 ± 1.79 mm (range, 21.25-33.09 mm). MOSH was the highest in the temporal direction, followed by the superior, nasal, and inferior directions (all p < 0.001). The MOSH of HM eyes was significantly higher than that of non-HM eyes, and it was positively correlated with AL in the nasal, temporal, and superior directions (all p < 0.001). Macular ChT was independently associated with the average MOSH (B = -0.190, p < 0.001). Nasal MOSH was positively associated with the PPA area and the presence of a tilted optic disc (both p < 0.01). Eyes with a higher MOSH in the superior (odds ratio [OR] = 1.008; p < 0.001) and inferior directions (OR = 1.006; p = 0.009) were more likely to have posterior staphyloma., Conclusion: MOSH is an early indicator of scleral deformation, and it is correlated positively with AL and negatively with ChT. A higher nasal MOSH is associated with a larger PPA area and the presence of a tilted optic disc. Higher MOSH values in the superior and inferior directions were risk factors for posterior staphyloma., Clinical Trial Registration: The study was registered at www., Clinicaltrials: gov (Reg. No. NCT03446300)., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Aim: To assess the role of the corneal radius of curvature (CR) in the identification of fundus tessellation in children with low myopia., Methods: In the cross-sectional study, students aged 9-12 years from 24 primary schools in Shanghai were enrolled by cluster sampling. Participants underwent measurements including cycloplegic refraction and axial length. Fundus images and choroidal thickness were obtained by swept-source optical coherence tomography. Fundus tessellation was classified into four grades according to fundus photographs., Results: A total of 1127 children with low myopia (spherical equivalence (SE) >-3.00 dioptre (D) but ≤-0.50 D) were included, with a mean age of 10.29±0.60 years and a mean SE of -1.44±0.69 D. Fundus tessellation was found in 591 (52.4%) cases (grade 1: 428, 38.0%; grade 2: 128, 11.4%; grade 3: 35, 3.1%). Choroidal thickness decreased as fundus tessellation grade increased (p trend <0.001). According to regression analysis, higher fundus tessellation grade was independently associated with larger CR (OR, 7.499; 95% CI 2.279 to 24.675, p=0.001). For those with CR >7.9 mm, along with CR, degree and proportion of fundus tessellation increased sharply., Conclusion: Fundus tessellation existed in more than half of children with low myopia. Preliminary fundus photography conducted in children with low myopia with large CR would be necessary and beneficial to the early management of myopic fundus changes. Trial registration number NCT02980445., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Community-based telemedicine screening for diabetic retinopathy (DR) has been highly recommended worldwide. However, evidence from low- and middle-income countries (LMICs) on the choice between artificial intelligence (AI)-based and manual grading-based telemedicine screening is inadequate for policy making., Objective: The aim of this study was to test whether the AI model is more worthwhile than manual grading in community-based telemedicine screening for DR in the context of labor costs in urban China., Methods: We conducted cost-effectiveness and cost-utility analyses by using decision-analytic Markov models with 30 one-year cycles from a societal perspective to compare the cost, effectiveness, and utility of 2 scenarios in telemedicine screening for DR: manual grading and an AI model. Sensitivity analyses were performed. Real-world data were obtained mainly from the Shanghai Digital Eye Disease Screening Program. The main outcomes were the incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR). The ICUR thresholds were set as 1 and 3 times the local gross domestic product per capita., Results: The total expected costs for a 65-year-old resident were US $3182.50 and US $3265.40, while the total expected years without blindness were 9.80 years and 9.83 years, and the utilities were 6.748 quality-adjusted life years (QALYs) and 6.753 QALYs in the AI model and manual grading, respectively. The ICER for the AI-assisted model was US $2553.39 per year without blindness, and the ICUR was US $15,216.96 per QALY, which indicated that AI-assisted model was not cost-effective. The sensitivity analysis suggested that if there is an increase in compliance with referrals after the adoption of AI by 7.5%, an increase in on-site screening costs in manual grading by 50%, or a decrease in on-site screening costs in the AI model by 50%, then the AI model could be the dominant strategy., Conclusions: Our study may provide a reference for policy making in planning community-based telemedicine screening for DR in LMICs. Our findings indicate that unless the referral compliance of patients with suspected DR increases, the adoption of the AI model may not improve the value of telemedicine screening compared to that of manual grading in LMICs. The main reason is that in the context of the low labor costs in LMICs, the direct health care costs saved by replacing manual grading with AI are less, and the screening effectiveness (QALYs and years without blindness) decreases. Our study suggests that the magnitude of the value generated by this technology replacement depends primarily on 2 aspects. The first is the extent of direct health care costs reduced by AI, and the second is the change in health care service utilization caused by AI. Therefore, our research can also provide analytical ideas for other health care sectors in their decision to use AI., (©Senlin Lin, Yingyan Ma, Yi Xu, Lina Lu, Jiangnan He, Jianfeng Zhu, Yajun Peng, Tao Yu, Nathan Congdon, Haidong Zou. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 23.02.2023.)

Purpose: To evaluate the efficacy of time outdoors per school day over 2 years on myopia onset and shift., Design: A prospective, cluster-randomized, examiner-masked, 3-arm trial., Participants: A total of 6295 students aged 6 to 9 years from 24 primary schools in Shanghai, China, stratified and randomized by school in a 1:1:1 ratio to control (n = 2037), test I (n = 2329), or test II (n = 1929) group., Methods: An additional 40 or 80 minutes of outdoor time was allocated to each school day for test I and II groups. Children in the control group continued their habitual outdoor time. Objective monitoring of outdoor and indoor time and light intensity each day was measured with a wrist-worn wearable during the second-year follow-up., Main Outcome Measures: The 2-year cumulative incidence of myopia (defined as cycloplegic spherical equivalent [SE] of ≤-0.5 diopters [D] in the right eye) among the students without myopia at baseline and changes in SE and axial length (AL) after 2 years., Results: The unadjusted 2-year cumulative incidence of myopia was 24.9%, 20.6%, and 23.8% for control, test I, and II groups, respectively. The adjusted incidence decreased by 16% (incidence risk ratio [IRR], 0.84; 95% confidence interval [CI], 0.72-0.99; P = 0.035) in test I and 11% (IRR = 0.89; 95% CI, 0.79-0.99; P = 0.041) in test II when compared with the control group. The test groups showed less myopic shift and axial elongation compared with the control group (test I: -0.84 D and 0.55 mm, test II: -0.91 D and 0.57 mm, control: -1.04 D and 0.65 mm). There was no significant difference in the adjusted incidence of myopia and myopic shift between the 2 test groups. The test groups had similar outdoor time and light intensity (test I: 127 ± 30 minutes/day and 3557 ± 970 lux/minute; test II: 127 ± 26 minutes/day and 3662 ± 803 lux/minute) but significantly more outdoor time and higher light intensity compared with the control group (106 ± 27 minutes/day and 2984 ± 806 lux/minute). Daily outdoor time of 120 to 150 minutes at 5000 lux/minutes or cumulative outdoor light intensity of 600 000 to 750 000 lux significantly reduced the IRR by 15%～ 24%., Conclusions: Increasing outdoor time reduced the risk of myopia onset and myopic shifts, especially in nonmyopic children. The protective effect of outdoor time was related to the duration of exposure and light intensity. The dose-response effect between test I and test II was not observed probably because of insufficient outdoor time achieved in the test groups, which suggests that proper monitoring on the compliance on outdoor intervention is critical if one wants to see the protective effect., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: China contributes to a significant proportion of the myopia in the world. The study aims to investigate the utilization of various correction methods and health service in urban China, and to estimate the cost of myopia treatment and prevention. In addition, we aimed to estimate the cost of productivity loss due to myopia., Methods: The study was a cross-sectional investigation carried out in urban areas in three provinces located in the east (Shanghai), middle (Anhui) and west part (Yunnan) of China, in 2016. A total of 23819 people aged between 5 to 50 years were included. Health utilization and the cost of myopia were analyzed from patients' perspective., Results: The total number of people with myopia in the urban China was estimated to be 143.6 million. The correction rate was 89.5%, 92.1%, and 92.7% for Anhui, Shanghai, and Yunnan (χ 2  = 19.5, P  < 0.01). Over the recent year, 20.6%, 16.8%, and 28.8% of myopic subjects visited hospital due to myopia, in Anhui, Shanghai and Yunnan. The annual cost of treatment and prevention of myopia was 10.1 billion US dollar (US$, floating from 9.2 to 11.2 billion US$), and the cost per person was 69US$. The annual cost of loss of productivity was estimated to be 6.7 billion US$ for those with mild to moderate visual impairment (floating from 6.1 to 7.4 billion US$), and 9.4 billion US$ (floating from 8.5 to 10.4 billion US$) for those with severe visual impairment to blindness. Therefore, the total economic burden of myopia was estimated as 173.6 billion CNY (26.3 billion US$)., Conclusions: The present study shows that myopia leads to substantial economic burden in China. The loss of productivity caused by myopia is an important part of the disease burden compared to the cost of correction and treatment paid by individuals. Therefore, the focus of myopia prevention and control should be to decrease the myopia prevalence, and prevent the uncorrected refractive errors and the irreversible damage of visual acuity by high myopia., Competing Interests: Competing interests: The authors completed the ICMJE Declaration of Interest Form (available upon request from the corresponding author), and declare no conflicts of interest., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

Purpose: To identify the association between the choroidal thickness (ChT) with age and axial length (AL) under different refractive errors (REs) in Chinese adults., Methods: Swept-source optical coherence tomography was used to measure ChT in 2126 right eyes of 2126 participants. The participants were classified as having pathologic myopia (PM), high myopia without PM (HM), low myopia (LM), and nonmyopia (non-M) according to their REs and META-PM (the Meta-Analysis of Pathologic Myopia) classification criteria., Results: The mean age was 52.49 ± 20.39 years (range, 18-93 years), and the mean RE was -5.27 ± 5.37 diopters (D; range, -25.5 to +7.75 D). The mean average ChT was 159.25 ± 80.75 µm and decreased in a linear relationship from non-M to PM (190.04 ± 72.64 µm to 60.99 ± 37.58 µm, P < 0.001). A significant decline in ChT was noted between 50 and 70 years (r = -0.302, P < 0.001) and less rapidly after the age of 70 years (r = -0.105, P = 0.024). No correlation was noted between age and ChT under 50 years (P = 0.260). A significantly higher association with AL was noted in the central fovea (βHM = -23.92, βLM = -23.88, βNon-M = -18.80, all P < 0.001) and parafoveal ChT (βHM = -22.87, βLM = -22.31, βNon-M = -18.61, all P < 0.001) when compared with the perifoveal region (βHM = -19.80, βLM = -18.29, βNon-M = -13.95, all P < 0.001). Within each group of PM, HM, LM, and non-M, regression analysis showed that the coefficients of age and AL with different macular regions of ChT varied significantly., Conclusions: ChT was negatively correlated with age after 50 years. The thinning of the choroid was more prominent in the center and parafoveal regions as AL increased. Varied distributions of ChT decrease associated with AL and age were noted among different refractive groups.

Objectives: To report on: (a) overall myopia and high myopia prevalence, and (b) the impact of education on the spherical equivalent refractive error in children across Shanghai., Design: Cross-sectional study., Setting: Across all 17 districts of Shanghai., Participants: 910 245 children aged 4-14 years from a school-based survey conducted between 2012 and 2013., Main Outcome Measures: Data of children with non-cycloplegic autorefraction, visual acuity assessment and questionnaire were analysed (67%, n=6 06 476). Prevalence of myopia (≤-1.0 D) and high myopia (≤-5.0 D) was determined. We used a regression discontinuity design to determine the impact of school entry cut-off date (1 September) by comparing refractive errors at each age, for children born pre-September to post-1 September, and performed a multivariate analysis to explore risk factors associated with myopia. Data analysis was performed in 2017-2018., Results: Prevalence rates of myopia and high myopia were 32.9% (95% CI: 32.8% to 33.1%) and 4.2% (95% CI: 4.1% to 4.2%), respectively. From 6 years of age onwards, children born pre-September were more myopic compared with those born post-1 September (ahead in school by 1 year, discontinuity at 6 years: -0.19 D (95% CI: -0.09 to -0.30 D); 14 years: -0.67 D (95% CI: -0.21 to -1.14 D))., Conclusions: Our findings suggest that myopia is associated with education, that is primarily focused on near-based activities. Efforts to reduce the burden should be directed to public awareness, reform of education and health systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To document one-year changes in refraction and refractive components in preschool children., Methods: Children, 3-5 years old, in the Jiading District, Shanghai, were followed for one year. At each visit, axial length (AL), refraction under cycloplegia (1% cyclopentolate), spherical dioptres (DS), cylinder dioptres (DC), spherical equivalent refraction (SER) and corneal curvature radius (CR) were measured., Results: The study included 458 right eyes of 458 children. The mean changes in DS, DC and SER were 0.02 ± 0.35 D, -0.02 ± 0.33 D and 0.01 ± 0.37 D, while the mean changes in AL, CR and lens power (LP) were 0.27 ± 0.10 mm, 0.00 ± 0.04 mm and - 0.93 ± 0.49 D. The change in the SER was linearly correlated with the baseline SER (coefficient = -0.147, p < 0.001). When the baseline SER was at 1.05 D (95% CI = 0.21 to 2.16), the change in SER was 0 D. The baseline SER was also linearly associated with the change in LP (coefficient = 0.104, p = 0.013), but not with the change in AL (p = 0.957) or with the change in CR (p = 0.263)., Conclusion: In eyes with a baseline SER less than +1.00 D, LP loss was higher compared to axial elongation, leading to hyperopic shifts in refraction, whereas for those with baseline SER over this range, loss of LP compared to axial elongation was reduced, leading to myopic shifts. This model indicated the homeostasis of human refraction and explained how refractive development leads to a preferred state of mild hyperopia., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the prevalence and associated factors of fundus tessellation in highly myopic children and adolescents., Methods: A total of 513 high myopes (spherical equivalent [SE] ≤ -5.0 D, 4-19 years of age) without any advanced pathological myopic lesions were enrolled. Fundus photographs and choroidal thickness (ChT) data were collected by SS-OCT. A novel grading approach was adopted to classify fundus tessellation into four categories on colour fundus photography, referring to the location of tessellation divided by an Early Treatment Diabetic Retinopathy Study grid centred on the fovea, through which closer to the fovea represents higher grades of fundus tessellation. Peripapillary atrophy (PPA) area and ovality index were also measured., Results: Among the participants, with a mean age of 13.47 ± 3.13 years and mean SE of - 8.34 ± 1.91 D, there were 29 (5.7%), 95 (18.5%), 233 (45.4%) and 156 (30.4%) participants with grade 0 to grade 3 fundus tessellation, respectively. The ChT in both the macular and peripapillary area was negatively correlated with the fundus tessellation grade (R = -0.763 and -0.537, respectively, all p < 0.001). Higher grades of fundus tessellation were independently associated with thinner macular ChT (OR = 1.734, 95% CI: 1.621-1.856, p < 0.001), longer axial length (OR = 1.368, 95% CI: 1.105-1.695, p = 0.004), larger PPA area (OR = 1.391, 95% CI: 1.073-1.802, p = 0.013) and the female sex (OR = 1.605, 95% CI: 1.092-2.359, p = 0.016)., Conclusion: The fundus tessellation grade could reflect the ChT, representing the severity of myopic maculopathy among young high myopes who rarely had any advanced lesions of pathological myopia. Fundus tessellation grade might be a potential index for assessing early-stage myopic maculopathy in children and adolescents., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To describe the methodology and pilot data of the Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM)., Methods: This is a population-based, prospective, examiner-masked study with annual follow-up. Patients are 4- to 18-year-olds with high myopia. The participants will fill out questionnaires and then undergo visual acuity, axial length (AL), intraocular pressure, ophthalmologist assessment, microperimetry, cycloplegic refraction, Pentacam, wavefront aberration, fundus, blood and saliva examinations. To describe the pilot data, intergroup differences were assessed with t-tests or analysis of variance and a logistic regression model was used to determine the independent factors associated with peripapillary atrophy (PPA)., Results: Overall, 134 eyes of 79 participants met the pilot study recruitment criteria. The mean AL and spherical equivalent were 26.91 ± 1.07 mm and -9.40 ± 1.77 D, respectively. Peripapillary atrophy (PPA) (N = 112) and tessellated fundus (N = 67) were the most common fundus changes. The mean AL was significantly longer in PPA (27.08 ± 0.93 mm) than in non-PPA eyes (26.06 ± 1.31 mm; p < 0.001). Axial length (AL) (p = 0.041) was the only independent factor associated with PPA. Axial length (AL) was significantly longer in eyes with diffuse chorioretinal atrophy (N = 11; 28.02 ± 1.31 mm) than without myopic retinal lesions (N = 56; 26.48 ± 0.91 mm, p < 0.001) or with tessellated fundus (N = 67; 27.09 ± 0.97 mm, p = 0.012). The myopic degree was higher in eyes with diffuse chorioretinal atrophy than without myopic retinal lesions (-10.51 ± 2.76 D versus -9.06 ± 1.58 D, p = 0.039)., Conclusion: Peripapillary atrophy and tessellated fundus were common in children and adolescents with high myopia. Results from this prospective study will help to understand the mechanisms, development and prognosis of these changes and can guide early myopia screening., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Background: Although an integral part of ethical and quality health care, little is known about the informed decision making of Chinese women with different socioeconomic backgrounds within the context of antenatal testing., Methods: To explore women's viewpoints on informed decision making regarding antenatal screening, a Q-methodology study that combines both quantitative factor analysis and interviews was conducted between June 2016 and February 2017 in Shanghai and Duyun. A total of 169 women (84 Shanghai and 85 Duyun) participated in the study of 41 ranked statements along a Q-sorting grid., Results: Using by-person factor analysis, five distinct viewpoints are identified: (a) choice is shared with the partner/husband, but the mother has the right to make the final decision; (b) having antenatal tests is not about choice but about a mother's responsibility; (c) choice is a shared decision led primarily by the partner/husband and secondarily by the doctors; (d) choice should be made using the advice of doctors, but the decision should be made with the partner/husband; and (e) choice is a responsibility shared with the partner, family and doctors., Conclusions: The study reveals that women with better education and higher incomes demonstrate more autonomy than those with less education. The nuclear family clearly emerges as the main decision makers in health-care services in China., Patient and Public Contribution: The 169 participants shared their views and stories for at least an hour. They were debriefed after the interviews and contributed their thoughts on our study design and interpretation of the data., (© 2020 The Authors Health Expectations published by John Wiley & Sons Ltd.)

Abstract: In patients with diffuse large B-cell lymphoma, MYC combined with Bcl2 and/or Bcl6-based protein expression is called double expression lymphoma (DEL). R-DA-EPOCH program chemotherapy is typically recommended because these patients often have a poor prognosis. Although numerous factors affect survival of patients with DEL, the roles of the tumor biomarker histone methyltransferase G9a (G9a) and the lymphocyte-to-monocyte ratio (LMR) are unknown.We performed a retrospective analysis of data from 51 patients. These patients were newly diagnosed with DEL and treated with R-DA-EPOCH at Taizhou People' s Hospital and Northern Jiangsu People's Hospital between June 2014 and December 2019. Receiver operator characteristic curve results were used to calculate the LMR cutoff value. We used an immunohistochemical analysis to examine G9a expression in DEL tissues. The Kaplan-Meier method was used to determine progression-free survival (PFS) and overall survival (OS) characteristics. Cox proportional-hazards models were constructed for univariate and multivariate analyses to examine the prognostic values of LMRs and G9a in patients with DEL.The cutoff value for LMR was 2.18. The 5-year PFS rate was 35.3%, and the 5-year OS rate was 39.2%. Patients with DEL with lower LMRs and who were G9a-positive predicted inferior PFS and OS. Univariate analysis revealed that patients with elevated LDH levels, high National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) scores, LMRs ≤2.18, and G9a-positive results had relatively poorer PFS and OS. The multivariate analysis revealed that LMRs ≤2.18 and a G9a-positive result were independent prognostic factors for PFS and OS in patients with DEL treated with R-DA-EPOCH.The study results suggested that peripheral blood LMRs were an important marker for evaluation of prognosis in patients with DEL. High expression of G9a was associated with worse outcomes, indicating that G9a may serve as a prognostic biomarker for patients with DEL who undergo R-DA-EPOCH program chemotherapy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China., Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed., Results: (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers., Conclusion: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.

Objective: To evaluate the 2-year incidence and associated factors of dry eye (DE) among community residents with type 2 diabetes mellitus (DM)., Methods: For confirmed type 2 DM residents in the Xinjing community of Shanghai in China, 2 surveys on DE and related factors were performed in 2016 and 2018. The survey content included general information, subjective symptom questionnaires, tear-film break-up time test, Schirmer I test, corneal fluorescence staining (FL), slit-lamp examination, and examination of blood and urine samples. Symptoms of depression were evaluated using the Center for Epidemiologic Studies Depression (CES-D) scale. Dry eye was diagnosed based on the diagnostic standards developed by the Asia Dry Eye Society in 2016., Results: The 2-year incidence of DE among 460 type 2 DM residents was 33.7% (95% confidence interval [CI]=29.6%-38.3%). The incidence of DE significantly increased with increasing age (P<0.01). The incidence among women (35.7%) was not statistically significant compared with that of men (31.0%). In the multivariate logistic regression model, age (odds ratio [OR]=1.03, 95% CI=1.01-1.06, P=0.04), corneal sensitivity (OR=0.97, 95% CI=0.94-0.99, P=0.03), and depressive symptom score (OR=1.04, 95% CI = 1.00-1.08, P=0.04) were associated factors for the incidence of DE. In the CES-D scale, two items, "I felt that everything I did was an effort" and "I felt sad," were significantly correlated with DE onset., Conclusion: The incidence of DE among community residents with type 2 DM was high. Screening for DE among DM residents, especially residents with advanced age, corneal hypoesthesia, and depression, should be strengthened.

Purpose: To analyze the relationships between choroidal thickness (CT) and diabetes mellitus (DM), diabetic retinopathy (DR), and DR severity in community residents diagnosed with type 2 DM, and to explore whether CT can improve the discriminatory ability of other risk factors to predict the incidence of DR., Methods: A total of 1,250 type 2 DM residents and 1,027 healthy controls in Xinjing community of Shanghai participated a cross-sectional survey of eye diseases in 2016. CT was measured using swept-source optical coherence tomography. DR was classified according to the 2002 international clinical classification of DR. A total of 537 subjects with type 2 DM without DR at the 2016 survey were followed up in 2018 to investigate the 2-year incidence of DR. Receiver operating characteristic curve analysis was used to test the accuracy of different indicators in predicting the onset of DR., Results: The central CT of the control, no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and PDR groups were 223.40, 216.22, 213.57, 211.91, 178.47, and 168.15 μm, respectively (p for trend <0.001), and the average CT (ACT) were 197.83, 186.94, 182.03, 178.00, 156.91, and 136.72 μm respectively (p for trend <0.001). Body mass index (BMI), DM duration, fasting blood glucose, glycosylated hemoglobin (HbA1C), and ACT were risk factors for 2-year DR incidence. For the onset of DR, as predicted by ACT, after tenfold cross validation the average area under the curve was 0.55 (p = 0.048). Addition of ACT did not improve the discriminatory ability of DM duration, BMI, glucose and HbA1C on the incidence of DR (Z = 0.48; p = 0.63)., Conclusions: As the severity of DR increased, the CT of community type 2 DM patients showed a significant downward trend compared with the healthy controls. Thinner ACT was found to be a risk factor for DR incidence, but it did not improve the discriminatory ability of other risk factors to predict the incidence of DR., (© 2020 S. Karger AG, Basel.)

Purpose: To investigate the characteristics, mergers, and risk factors of different types of myopic maculopathy (MM) in a highly myopic population., Design: Population-based, cross-sectional study., Methods: A total of 1086 eyes (762 patients) were enrolled. Each participant underwent detailed ocular examinations. Combining the fundus photographs and optical coherence tomography images, types of MM were assessed as myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), or myopic neovascular maculopathy (MNM) according to the ATN classification system. Peripapillary atrophy (PPA) area, tilt ratio, and macular choroidal thickness (mChT) were measured individually., Results: Eyes with larger PPA area were more likely to have MAM (odds ratio [OR], 1.220; P = .037 per 1-mm 2 increase) and MNM (OR, 1.723; P < .001 per 1-mm 2 increase), and eyes with thicker mChT were less likely to have MAM (OR, 0.740; P < .001 per 10-μm increase) and MNM (OR, 0.784; P < .001 per 10-μm increase), whereas eyes with higher tilt ratio were less likely to have MTM (OR, 0.020; P < .001 per 1 increase). The severity of MTM and MNM was not precisely consistent with that of MAM., Conclusions: Different types of MM have different risk factors; larger PPA area and thinner mChT are risk factors for MAM and MNM, whereas lower tilt ratio is a risk factor for MTM. Our results indicate that the pathogenesis of MTM is different from that of MAM and MNM, and a tractional component should be considered as a possible component to the myopic macular classification., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to describe the normative values, distribution patterns, and correlated factors of macular ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex (GCC), and outer retinal layer (ORL) thicknesses in Chinese children., Methods: A sample of 3000 healthy children with different refractive status aged 6 to 19 years was consecutively examined. Demographics were recorded, and a comprehensive ophthalmic examination including refractive error and axial length (AL) was taken from all participants. The GCIPL, GCC, and ORL thicknesses were measured using swept source-optical coherence tomography (OCT), and multiple linear regression was used to determine which factors were associated with the thickness of each layer., Results: The average thickness was 77.00 ± 4.78 μm (95% confidence interval [CI]: 69.56-84.56 μm) in the GCIPL, 107.68 ± 5.95 μm (95% CI: 98.45-117.21 μm) in the GCC, and 178.57 ± 9.02 μm (95% CI: 164.33-192.56 μm) in the ORL. Multiple regression analysis indicated that GCIPL thickness was associated with sex (β = 0.168, P < 0.001), age (β = 0.126, P < 0.001), axial length (β = -0.181, P < 0.001), and refractive error (β = 0.233, P < 0.001). Age (β = 0.154, P < 0.001), sex (β = 0.102, P < 0.001), and refractive error (β = 0.149, P < 0.001) were associated independently with GCC thickness after adjusting for the other factors. Furthermore, age (β = 0.100, P < 0.001), sex (β = 0.163, P < 0.001), AL (β = -0.283, P < 0.001), and refractive error (β = 0.207, P < 0.001) were the independent factors associated with ORL thickness., Conclusions: The present study established a normative pediatric database for macular layer thicknesses in healthy Chinese children, advancing the ability of OCT in diseases diagnosis and monitoring among children.

Purpose : To evaluate common strategies for screening myopia. Methods : A total of 2,248 children aged 6 to 12 years from five randomly selected primary schools were included for the screening. Enrolled study participants underwent distant uncorrected visual acuity (UCVA, Standard Logarithmic Visual Acuity E Chart) and non-cycloplegic auto-refraction (NCAR, Topcon KR-8800). Among them, 1,639 children (72.9%) accepted cycloplegic auto-refraction. Taking rejection of cycloplegia into account, receiver operating characteristic curves were drawn to compare the accuracies of the four strategies (I, Cycloplegic auto-refraction; II, NCAR; III, UCVA; IV, Combination of UCVA and NCAR). Decision curve analysis (DCA) was used to compare net benefits. Tenfold cross-validation was used for statistical analyses. Results : For myopia (spherical equivalent refraction, SE ≤ -0.5D) screening, the mean sensitivities were 73.79% (SD: 5.40%), 85.57% (6.84%), 59.71% (13.49%), and 85.06% (6.68%) for Strategy I to IV; with mean specificities of 100% (0%), 87.43% (4.27%), 89.74% (10.25%), and 88.65% (5.07%), respectively. For screening early myopia (SE ≤ -0.5D and ≥-1.0D), the mean sensitivities were 73.44% (7.69%), 82.39% (5.32%), 54.27% (14.58%), and 81.76% (9.60%) for Strategy I to IV; with mean specificities of 100% (0%), 79.13% (4.86%), 85.48% (9.86%), and 81.17% (4.16%). Based on DCA, the net benefits of Strategy IV were the highest, with the probability thresholds ranging from 12% to 50%, after adjusting the TestHarms. For early myopia, the net benefits of Strategy IV were the highest with the probability threshold ranging from 5% to 34%. Conclusion : Combination of UCVA and NCAR produced the highest net benefits for myopia screening.

Purpose: To explore the subfoveal thickness of sclera (SST), choroid (SCT) and retina (SRT) as well as their relationship in healthy Chinese children with varying levels of refractive error., Methods: A total of 810 healthy Chinese schoolchildren and adolescents underwent a series of comprehensive ocular examinations, as well as swept-source optical coherence tomography (OCT) after induced cycloplegia. The thicknesses of the sclera, choroid and retina below the central fovea were measured manually, and each measurement was compared across different refractive statuses. Independent factors associated with the thickness of each layer were analysed., Results: The mean SST, SCT and SRT were 524 ± 57 μm, 195 ± 49 μm and 224 ± 19 μm, respectively. The SSTs and SCTs of myopes were significantly thinner than those of emmetropes and hyperopes (all p < 0.001). Although the choroid seemed to be thicker in hyperopes (225 ± 46 μm) than in emmetropes (211 ± 45 μm), no statistically significant difference was observed between emmetropes and hyperopes in the sclera and choroid. Thinner SSTs and SCTs were associated with greater levels of myopia, whereas the SRT was similar in children with different myopic levels. SST (p < 0.001) and SCT (p = 0.003) as well as age (p < 0.001), sex (p < 0.001) and axial length (p < 0.001) were independently associated with spherical equivalent refraction (SER). Older age (p = 0.013), myopic-shifted SER (p < 0.001), thicker SCT (p < 0.001) and thinner SRT (p = 0.012) were independently associated with a thinner SST., Conclusion: The subfoveal sclera and choroid were thinner in myopes than in emmetropes and hyperopes, while the retina remains constant. Age, refractive error and choroidal and retinal thicknesses are related to subfoveal scleral thickness., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica.)

Importance: Cohort studies could not only reveal associations between change of refractive components and onset/progression of myopia, but also risk factors, which is important for understanding mechanism and providing strategies., Background: Prevalence of myopia is high in Shanghai, being reported to be 52.2% in children aged 10 years old., Design: Cohort study., Participants: A total of 1856 students from six randomly selected primary schools in Baoshan District, Shanghai., Methods: Children underwent comprehensive ocular measurement, including axial length (AL), corneal curvature radius and cycloplegic auto-refraction. Questionnaires about eye usage time were collected. Grade 1 students were followed for 4 years, and grade 2 and 3 students for 2 years., Main Outcome Measures: (i) Change of spherical equivalent (SE) and AL and (ii) risk factors for progression and incidence of myopia., Results: The average 2-year progress of SE was 0.91D, 0.91D and 1.11D for grade 1, 2 and 3, respectively, and the average elongation of AL was 0.70 mm, 0.64 mm and 0.71 mm, respectively. Only parental myopia, but not near work time, near work diopter time, outdoor activity time or attending tutoring classes, was associated with myopia incidence and progression in the present population. Using baseline SE could be a simple and effective indicator for myopia prediction., Conclusions and Relevance: Incidence and progression of myopia is relatively high in schoolchildren in Shanghai compared with children of Western countries, East Asia and other parts of China. Effective strategies to control myopia prevalence are in urgent need., (© 2018 The Authors Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

The concept of informed choice for antenatal screening consists of Western ideologies, encapsulating individualistic approaches, and may be valued differently by people from countries with more collectivist cultures. This study aimed to explore perceptions of informed choice in antenatal screening in women from China, Hong Kong and Pakistan. A Q-methodology study was conducted during June 2016 to February 2017, in China (Shanghai and Duyun), Hong Kong and Pakistan (Lahore). A total of 299 women rank ordered 41 statements. Following by-person factor analysis, five distinct viewpoints were identified: choice as a maternal responsibility entrusted to doctors; choice as a shared decision led by the mother; choice as a shared decision led by the partner; choice as a responsibility delegated to the partner and doctors; and choice within a religious discourse. The findings highlight ethical dilemmas for healthcare professionals in facilitating informed choice for antenatal screening where policy and practice guidelines adapt predominantly individualistic approaches. Women's preferences for decision-making with health professionals and/or their partner, with minimal emphasis on individual rights, suggest the need for clarification of the role of health professionals in supporting and facilitating decision-making to enhance women's autonomy. Policy and practice guidelines need to be (re)framed to facilitate decision-making processes for antenatal screening using relational approaches to autonomy.

Purpose: To determine the relationship between choroidal thickness (ChT) at the posterior pole and refractive error and to explore the difference between the macular and peripapillary regions in children with myopia., Methods: A total of 340 healthy Chinese children underwent a series of comprehensive ocular examinations including cycloplegic refraction. Swept-source optical coherence tomography was used to measure the ChT in the macular and peripapillary regions. The Early Treatment of Diabetic Retinopathy Study grid was applied to define the sectors., Results: The mean spherical equivalent (SE) of the participants was -1.71 ± 2.22 diopter (D; range from -7.63 to 4.25 D). The mean ChT in the central foveal, parafoveal, and perifoveal regions were 229 ± 65 μm, 227 ± 60 μm, and 215 ± 50 μm, respectively, and the mean global peripapillary choroidal thickness (PPCT) was 136 ± 33 μm. The choroid in the macular region and the global PPCT was thinner in myopes compared to hyperopes. The area between the central fovea and the optic disc underwent the largest change as myopia worsened. SE, uncorrected visual acuity, cornea curvature radius (CR), retinal thickness (RT), and retinal nerve fiber layer thickness (RNFLT, except for the central fovea) were the independent factors of ChT in the macular region. SE, CR, RT, and RNFLT were the independent factors of PPCT temporally, inferiorly, and globally, while only CR, RT, and RNFLT were independently associated with PPCT superiorly and nasally., Conclusions: Choroidal thinning might be uneven during the development of myopia. SE only influenced the macular area and sectors temporal and inferior to the optic disc.

Purpose: To investigate the relationship between lens power and age as well as the relationship between lens power and axial length (AL) in Chinese children and adolescents., Methods: The participants underwent a comprehensive ophthalmic examination that included AL, cycloplegic refraction, and Pentacam measurements. The crystalline lens power was calculated using Bennett's formula and then compared among the children of different age groups, refractive statuses, and AL categories. The association of lens power and AL was analyzed using multiple regression., Results: A total of 1992 children and adolescents aged 6- to 18-years old were included. The difference in lens power was greater before 10-years old, followed by a relatively smaller difference in children aged 10 to 14 years and the difference in lens power came to a near plateau in adolescents after 14-years old. The negative association between lens power and AL was found to be more evident in nonmyopes than in myopes irrespective of age (younger than 10 years: nonmyopes: β = -1.499, myopes: β = -0.872; older than 10 years: nonmyopes: β = -1.288, myopes: β = -0.390, all P < 0.001)., Conclusions: The lens power in children and adolescents aged 6 to 18 years exhibited three stages. The association between lens power and AL differed between the nonmyopes and myopes. These findings suggested that less reduction in lens power might be associated with both growing age and increasing AL in myopes.