Retinal nerve fiber layer defects and chronic kidney disease:the Kailuan Eye Study

AIM:To investigate whether retinal nerve fiber layer defects(RNFLDs)is a potential risk factor for chronic kidney disease(CKD)in Chinese adults.METHODS:The Kailuan Eye Study was a populationbased study that included 14440 participants.All participants underwent detailed assessments,RNFLDs were diagnosed using color fundus photographs.RESULTS:Overall,12507 participants[8533 males(68.23%)]had complete systemic examination data and at least one evaluable fundus photograph.RNFLDs were found in 621 participants[5.0%;95%confidence interval(CI):4.6%-5.34%],and 70 cases of multiple RNFLDs were found(11.27%).After adjusting multiple factors,RNFLDs was significantly associated with CKD severity,the ORs of CKD stage 3,stage 4 and stage 5 were 1.698,4.167,and 9.512,respectively.Multiple RNFLDs were also associated with CKD severity after adjusting multiple factors,the ORs of CKD stage 3 and stage 5 were 4.465 and 11.833 respectively.Furthermore,2294 participants had CKD(18.34%,95%CI:17.68%-18.99%).After adjusting for other factors,CKD presence was significantly correlated with the presence of RNFLDs.CONCLUSION:The strongest risk factors for RNFLDs are CKD and hypertension.Conversely,RNFLDs can be an ocular feature in patients with CKD.Fundoscopy can help detect systemic diseases,and assessment for RNFLDs should be considered in CKD patients.

Analysis of risk and protective factors associated with retinal nerve fiber layer defect in a Chinese adult population

AIM:To investigate the risk and protective factors associated with the retinal nerve fiber layer defect(RNFLD)in a Chinese adult population.METHODS:This study was a cross-sectional populationbased investigation including employees and retirees of a coal mining company in Kailuan City,Hebei Province.All the study participants underwent a comprehensive systemic and ophthalmic examination.RNFLD was diagnosed on fundus photographs.Binary logistic regression was used to investigate the risk and protective factors associated with the RNFLD.RESULTS:The community-based study included 14440 participants.There were 10473 participants in our study,including 7120 males(68.0%)and 3353 females(32.0%).The age range was 45-108y,averaging 59.56±8.66y.Totally 568 participants had RNFLD and the prevalence rate was 5.42%.A higher prevalence of RNFLD was associated with older age[P<0.001,odds ratio(OR):1.032;95%confidence interval(CI):1.018-1.046],longer axial length(P=0.010,OR:1.190;95%CI:1.042-1.359),hypertension(P=0.007,OR:0.639;95%CI:0.460-0.887),and diabetes mellitus(P=0.019,OR:0.684;95%CI:0.499-0.939).The protective factors of RNFLD were visual acuity(P=0.038,OR:0.617;95%CI:0.391-0.975),and central anterior chamber depth(P=0.046,OR:0.595;95%CI:0.358-0.990).CONCLUSION:In our cross-sectional community-based study,with an age range of 45-108y,RNFLD is associated with older age,longer axial length,hypertension,and diabetes mellitus.The protective factors of RNFLD are visual acuity and central anterior chamber depth.These can help to predict and evaluate RNFLD related diseases and identify high-risk populations early.

10-year fundus tessellation progression and retinal vein occlusion

AIM： To access the 10-year fundus tessellation progression in patients with retinal vein occlusion. METHODS： The Beijing Eye Study 2001/2011 is a populationbased longitudinal study. The study participants underwent a detailed physical and ophthalmic examination. Degree of fundus tessellation was graded by using fundus photographs of the macula and optic disc. Progression of fundus tessellation was calculated by fundus tessellation degree of 2011 minus degree of 2001. Fundus photographs were used for assessment of retinal vein occlusion. RESULTS： The Beijing Eye Study included 4403 subjects in 2001, 3468 subjects was repeated in 2011. Assessment of retinal vein obstruction and fundus tessellation progression were available for 2462 subjects（71.0%）, with 66 subjects fulfilled the diagnosis of retinal vein occlusion. Of the 66 participants, 59 participants with unilateral branch retinal vein occlusion, 5 participants with unilateral central retinal vein occlusion, 1 participant with bilateral branch retinal vein occlusion, and 1 participant with branch retinal vein occlusion in one eye and central retinal vein occlusion in the other eye. Mean degree of peripapillary fundus tessellation progression were significantly higher in the whole retinal vein occlusion group（0.33±0.39, P〈0.001）, central retinal vein occlusion group（0.71±0.8, P=0.025） and branch retinal vein occlusion group（0.29±0.34, P=0.006） than the control group（0.20±0.26）. After adjustment for age, prevalence of tilted disc, change of best corrected visual acuity, axial length, progression of peripapillary fundus tessellation was associated with the presence of retinal vein occlusion（P=0.004; regression coefficient B, 0.094; 95%CI, 0.029, 0.158; standardized coefficient B, 0.056）. As a corollary, after adjusting for smoking duration, systolic blood pressure, anterior corneal curvature, prevalence of RVO was associated with more peripapillary fundus tessellation progression（P〈0.001; regression coefficient B： 1.257; OR： 3.517; 95%CI： 1.777, 6.958）. CONCLUSION： Peripapillary fundus tessellation progresses faster in individuals with retinal vein occlusion. This may reflect the thinning and hypoperfusion of choroid in patients with retinal vein occlusion.

Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy--the Kailuan Eye Study

AIM:To explore the influencing factors of diabetes type 2 patients with mild non-proliferative diabetic retinopathy(NPDR)in the Kailuan area of Tangshan,Hebei Province,China.METHODS:In this non-interventional,retrospective study,683 patients with type 2 diabetes were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study.Based on the undilated ultrawide field(200°;UWF)images and partial dilated digital fundus images,the diabetic retinopathy(DR)of the surveyed population was graded.Interobserver agreement was estimated by using Cohen’s Kappa statistics.The main outcome indicators included gender,age,weight,height,body mass index,blood pressure,circumferences of neck,waist and hip,current smoking,levels of fasting plasma glucose(FPG),hypersensitive C-reactive protein,creatinine,and cholesterol,etc.According to different lesions’locations of patients with mild NPDR,logistic regression models were used to estimate the odds ratios(ORs)and their 95%Cls of each risk factor.RESULTS:The study group of 683 patients included 570 males and 113 females.The mean age of the patients was62.18±9.41 y.Compared with dilated fundus examinations,there was fair agreement with the level of DR identified on UWF images in 63.91%of eyes(k=0.369,95%CI,0.00-0.00).Detected by UWF images,there were 98 patients with mild NPDR having peripheral retinal lesions,35 patients with mild NPDR having posterior lesions,44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area,and 336 patients with non obvious DR.Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance(OR,1.124;95%CI,1.044-1.211),and with posterior lesions were FPG(OR,1.052;95%CI,1.007-1.099).CONCLUSION:UWF is an effectiveness means of DR screening.Moreover,it is necessary to evaluate peripheral diabetic retinal lesions which can help to estimate the severity of DR.The phenomenon that nonuniform and inhomogeneous distribution of DR lesions has been found.And the influencing factors in mild NPDR are differing by different lesions’locations.

Correlation of the history of stroke and the retinal artery occlusion: a nested case-control study

AIM:To analyze the systemic factors including stroke history related to the retinal artery occlusion(RAO).METHODS:Patients with an exact diagnosis of RAO in the medical database of the Kailuan Corporation were identified as the case group.Five patients without RAO were added for each case from the Kailuan Study and matched for sex and age(age±2)as the control group.The Kailuan Study is a general population-based cohort study in northern China,in which a total of 101510 individuals(81110 men)aged 18-98 y were recruited to participate in the study.And the participants were bi-annually reexamined.The database of both groups was from Kailuan study of 2010 cohort.All the information,including the demographic characteristics,lifestyle behaviors,medical comorbidities,medical history,family medical history,drug usage,anthropometric measurements,blood pressure measurement,blood sample laboratory assessment,urine tests,and other physical examinations were all collected.A retrospective nested case-control method was used for this study.Conditional multivariate logistic regression was used to analyze the risk factors with SPSS 13.0 software and SAS 9.3 software.RESULTS:A total of 45 patients were included as the case group,and the control group included 225 patients.In the case group,28 patients(62.2%)had a central retinal artery occlusion(CRAO),and 17 patients(37.8%)had a branch retinal artery occlusion(BRAO).A total of 18 patients(40.0%)had a stroke before the RAO(mean 4.04±3.88 y before the RAO),and 31 patients(81.6%)had infarctions or malacia identified by the cranial computed tomography(CT)scans.The basal ganglia and centrum semiovale were the most frequently involved regions.Plaques in the common carotid artery were present in 32 patients(88.9%).Conditional multivariate logistic regression analysis showed that the RAO was found to be associated with the history of stroke(P=0.0023,OR=28.794;95%CI:3.322-249.586).CONCLUSION:A history of stroke can significantly increase the incidence of RAO.Exists of plaque in the carotid artery is mean more than its severe stenosis for RAO.

Self-esteem enhancement as a strategy for promoting the mental health and averting the occupational problems of nurses

In recent years, shortage of nurses, high turnover rate, low self-worth, and team instability have become increasingly serious. With the development of positive psychology, more and more nursing managers have begun to attach great importance to the mental health of nurses. Self-esteem, as one of the core indicators of individual mental health, has received extensive attention from researchers in different fields since its inception. This paper reviews and summarizes the research status and development trends of nurses' selfesteem considering the aspects of self-esteem as a concept, assessment tools, significance, and intervention methods. At the same time, it also puts forward problems that need to be solved by undertaking research into nurses' self-esteem, in order to provide a reference for further studies on nurses' self-esteem.

Retinal nerve fiber layer thickness and retinal vascular caliber alterations in coal miners in northern China:a community-based observational study

AIM:To evaluate retinal nerve fiber layer thickness and retinal vascular caliber alterations in coal mine workers.METHODS:The community-based observational crosssectional study included 4004 participants of a subpopulation of the Kailuan Study.All the study participants underwent structured interviews with a standardized questionnaire,fundus photography and spectral-domain optical coherence tomography(OCT)examinations performed by trained doctors.RESULTS:The retinal nerve fiber layer thickness was significantly higher(P=0.006)and the central macular thickness was lower in coal miners(n=659,51.0±7.8 y)as compared to the control(working above the ground;n=477,51.8±7.5 y;P=0.032).Additionally,the downhole workers showed a significantly thicker retinal artery(P=0.012)and vein diameters(P<0.001).In multivariable regression,a thicker retinal nerve fiber layer was associated with a higher cumulative silica dust exposure(P=0.005)after adjusting for younger age and larger spherical equivalent.In a reverse pattern,a higher cumulative silica dust exposure(P=0.004)was significantly associated with a thicker retinal nerve fiber layer after adjusting for age,high-density lipoproteins and uric acid.Wider retinal vein diameters were associated with higher cumulative silica dust exposure(P=0.036)after adjusting for younger age and larger spherical equivalent.CONCLUSION:The retinal vessels diameters and retinal nerve fiber layer thickness are significantly thicker in long term of coal mining.The results of our study indicate that underground working environment may lead to retinal vessel dilation and inflammation.Thus,ocular examination might be needed within coal miners in order to monitor the occupational eye health as well as the incidence and progression of eye diseases.

The research status of self-care agency assessment and intervention of enterostomy patients

Objective:To discuss the research status of self-care agency assessment and intervention of enterostomy patients at home and abroad,and to provide reference for medical staff to understand the defects and needs of self-care agency of enterostomy patients and implement effective intervention.Methods:By searching the literature comprehensively,the latest research progress of self-care agency assessment and intervention of enterostomy patients at home and abroad was summarized.Results:The self-care agency assessment tools for patients with enterostomy included Stoma Self-Care Scale(SSCS),Specific Self-Care for Ostomized Patients Questionnaire(CAESPO)and Self-Care Competence of the Person with an Intestinal Stoma:Nursing School of Porto(CAO-EI:ESEP).Interventions included extended care,educational intervention and multidisciplinary team nursing.Conclusion:The concept of renewal should be used to evaluate the self-care agency of enterostomy patients from various aspects.In the future,we should actively carry out standardized research on the content and time of extended nursing and educational intervention,promote the extensive and standardized implementation of multidisciplinary team nursing,and promote the comprehensive improvement of self-care agency of enterostomy patients.

基于大语言模型的糖尿病管理:潜力与展望

The increasing prevalence of diabetes has become a global public health concern in the 21st century.In 2021,it was estimated that 537 million people had diabetes,and this number is projected to reach 643 million by 2030,and 783 million by 2045[1].Such a huge burden of diabetes brings great challenges in its prevention and management,including early diagnosis,timely interventions,and regular monitoring of risk factor control and complications screening.Continuous self-care support and patient empowerment can enhance clinical and psychobehavioural outcomes[2],although these require additional resources including manpower,infrastructure(hard and technology),and finances.The emergence of digital health technologies(DHTs),especially artificial intelligence(AI),may help address these obstacles and alleviate the burden of diabetes[3].Large language models(LLMs),a generative AI that can accept image and text inputs and produce text outputs,have shown promise in various aspects of medical care.

Systemic-Related Factors of Nonarteritic Anterior Ischemic Optic Neuropathy

To the Editor： Nonarteritic anterior ischemic optic neuropathy （NAION） is an acute optic neuropathy disease that is common in the elderly. The incidence of NA1ON is approximately （2.3-10.2）/100,000, and both eyes are involved in many patients. Xu et al. reported that the incidence in the Chinese population was 1/16,000. Acute visual acuity （VA） damage without any pain and a poor prognosis are the main features of NAION. This study aimed to find the related risk factors for NAION in average individuals to promote the prevention or early diagnosis of NAION.