青少年屈光不正眼在不同调节状态下晶状体的变化特点

目的:观察青少年远视眼与近视眼在不同调节状态下晶状体参数的动态变化,分析其差异并探讨晶状体变化的特点。方法:随机选取2019-01/10于我院门诊就诊的7~15岁青少年屈光不正患者50例86眼,分为近视组(29例46眼,平均等效球镜度-2.17±1.41D)和远视组(21例40眼,平均等效球镜度1.92±1.49D)。通过光学生物测量仪(IOL Master)测量眼轴长度(AL),通过眼前节光学相干断层扫描分析仪(SS-OCT)观察不同调节状态下(0、-3、-6D)晶状体厚度(LT)、晶状体前表面曲率半径(ALRC)、晶状体后表面曲率半径(PLRC)的动态变化。结果:调节放松状态下(0D),近视组LT显著小于远视组,ALRC与PLRC大于远视组(均P<0.01),且远视组眼轴短于近视组(22.49±1.12mm vs 24.48±0.82mm,P<0.01)。随着调节刺激的增大(-3、-6D),两组LT均显著增厚,ALRC与PLRC均显著减小(均P<0.01)。-3、-6D调节状态下,两组ALRC变化率均高于PLRC变化率(P<0.01),但两组间LT变化率及PLRC变化率均无显著差异(P>0.05),而远视组完成-6D调节时ALRC变化率显著大于近视组(P<0.05)。结论:调节刺激下青少年屈光不正眼晶状体厚度增加,形态变凸,其前表面的变化程度显著大于后表面,完成大幅度调节时,远视眼晶状体前表面的形变程度显著大于近视眼。

Analogs of microgravity: the function of Schlemm's canal, intraocular pressure and autonomic nervous during the head-down tilt test in healthy subjects

AIM:To evaluate the ocular outcomes and to elucidate possible mechanisms underlying intraocular pressure(IOP)change following the head-down tilt(HDT)test.METHODS:The study included 21 participants at the Department of Ophthalmology of Tongji Hospital.Subjects received the test of I-care tonometry,enhanced depth imaging optical coherence tomography and heart rate variability(HRV)analysis before and after 15 min HDT test.The lumen area of Schlemm’s canal(SCAR),IOP,HRV were calculated.RESULTS:IOP increased significantly after 20°head down position from 14.0±3.0 to 17.0±3.3 mm Hg(P<0.001).SCAR decreased from 13449.0±5454.9μm^(2) at sitting condition to 9576.6±4130.9μm^(2) post 15 min HDT test.High frequency(HF)indices increased significantly from 1462±865 Hz at baseline to 2128±824 Hz.Heart rate(HR)decreased significantly from 76±11.48 to 70±11.52 bpm after the HDT.The linear regression analysis showed that the difference of HF and SCAR significantly correlated with each other during the HDT(R^(2)=20%,P=0.04).CONCLUSION:These outcomes perform the first evidence of the activation of autonomic nervous system of HDT may cause the collapse of Schlemm’s canal lumen,which in turn leading to the increased IOP.

The Effects of Simulation-Based Learning Using Virtual Reality in Nursing Student:A Meta-Analysis

Purpose:This study is a meta-analysis to assess the effect of simulation-based learning using virtual reality(VR)on knowledge,affective,and performance domain outcomes of learning in nursing students.Methods:A literature search was conducted using Cochrane library,PubMed,EMBASE,Web of Science,ProQuest,ScienceDirect,Springer and Ovid eight electronic English databases,independently by 2 of the authors from January 2008 to December 2018.The RevMan 5.3 program of the Cochrane library was used to analyze the data with mean and standardized differences.Results:A total of 10 studies(5 randomized control trials(RCTs)and 5 non-RCTs)involved 630 nursing students.As a whole,simulation-based learning using VR appeared to have beneficial effects on the knowledge(I2=50%,95%CI 0.35[0.09,0.62],P=0.009),have no significant difference on the performance(I2=97%,95%CI 1.05[-0.54,2.63],P=0.19)and have a negative impact on the affective field(I2=0%,95%CI-0.43[-0.71,-0.15],P=0.003).Conclusion:The existing evidences imply that simulation-based learning using VR might have a positive trend that is beneficial to knowledge and clinical skill acquisition.However,the best way of integration still needs further research to be identified.

Changes in Schlemm’s canal,trabecular meshwork,and relevant parameters in the early stage after SMILE of myopia patients

AIM:To observe the changes in Schlemm’s canal(SC),trabecular meshwork(TM),and anterior chamber relevant parameters after small incision lenticule extraction(SMILE) of myopia patients.METHODS:A total of 58 eyes from 30 patients who underwent SMILE were divided into a low and moderate myopia group(group A,32 eyes) and a high myopia group(group B,26 eyes).The diameter and area of the SC,the width and thickness of TM obtained by CIRRUS HD-OCT5000,and the related anterior chamber parameters obtained by Pentacam anterior segment analysis system,accommodation amplitude(AMP) were observed pre-and postoperatively.The preoperative intraocular pressure(IOP) and postoperative correction of intraocular pressure(IOPcc) were measured.RESULTS:The diameter and area of the SC in the two groups were significantly increased postoperatively(all P<0.01).The TM width of the patients in the two groups were increased at 1mo after surgery(both P<0.01),but the TM thickness did not change(P>0.05).The corneal curvature,central anterior chamber depth,and anterior chamber volume decreased after SMILE surgery(all P<0.01).There was a weak negative correlation between the SC area change and AMP change in group A(r=-0.362,P<0.01).The postoperative IOP decreased after correction by Shah formula(P<0.05).CONCLUSION:SC and TM in myopia patients change in the early postoperative stage of SMILE and the IOP is decline.

Ocular biometry in the adult population in rural central China: a population-based, cross-sectional study

·AIM: To describe the distribution and determinants of ocular biometric parameters and to ascertain the relative importance of these determinants in a large population of adults in rural central China.·METHODS: A population-based, cross-sectional study performed in rural central China included 1721 participants aged 40 or more years. Ocular biometrical parameters including axial length(AL), anterior chamber depth(ACD), radius of corneal curvature(K) and horizontal corneal diameter [white-to-white(WTW)distance] were measured using non-contact partial coherence interferometry [intraocular lens(IOL)-Master].·RESULTS: Ocular biometric data on 1721 participants with a average age of 57.0 ±8.7y were analyzed at last.The general mean AL, ACD, mean corneal curvature radius(MCR), WTW were 22.80±1.12, 2.96±0.36, 7.56±0.26 and 11.75 ±0.40 mm, respectively. The mean values of each parameter in 40 to 49, 50 to 59, 60 to 69, and 70 to91 years age groups were as follows: AL, 22.77 ±0.87,22.76 ±1.06, 22.89 ±1.41, 22.92 ±0.80 mm; ACD, 3.10 ±0.32,2.98 ±0.34, 2.86 ±0.36, 2.77 ±0.35 mm; MCR, 7.58 ±0.25,7.54 ±0.26, 7.55 ±0.26, 7.49 ±0.28 mm; WTW, 11.79 ±0.38,11.75 ±0.40, 11.72 ±0.41, 11.67 ±0.41 mm. The AL, ACD,MCR and WTW were correlated with age and the AL was correlated with height and weight.·CONCLUSION: Our findings can serve as an important normative reference for multiple purposes and may help to improve the quality of rural eye care.

In vivo quantification of human aqueous veins by enhanced depth imaging optical coherence tomography and optical coherence tomography angiography images

AIM:To investigate the aqueous vein in vivo by using enhanced depth imaging optical coherence tomography(EDI-OCT)and optical coherence tomography angiography(OCTA).METHODS:In this cross-sectional comparative study,30 healthy participants were enrolled.Images of the aqueous and conjunctival veins were captured by EDI-OCT and OCTA before and after water loading.The area,height,width,location depth and blood flow of the aqueous vein and conjunctival vein were measured by Image J software.RESULTS:In the static state,the area of the aqueous vein was 8166.7±3272.7μm^(2),which was smaller than that of the conjunctival vein(13690±7457μm^(2),P<0.001).The mean blood flow density of the aqueous vein was 35.3%±12.6%,which was significantly less than that of the conjunctival vein(51.5%±10.6%,P<0.001).After water loading,the area of the aqueous vein decreased significantly from 8725.8±779.4μm^(2)(baseline)to 7005.2±566.2μm^(2)at 45min but rose to 7863.0±703.2μm^(2)at 60min(P=0.032).The blood flow density of the aqueous vein decreased significantly from 41.2%±4.5%(baseline)to 35.4%±3.2%at 30min but returned to 45.6%±3.6%at 60min(P=0.021).CONCLUSION:The structure and blood flow density of the aqueous vein can be effectively evaluated by OCT and OCTA.These may become biological indicators to evaluate aqueous vein changes and aqueous outflow resistance under different interventions in glaucoma patients.

An Analysis of the Application of the Suggestions of Clinical Practice Guideline for Ostomy Care in China:A Cross-Sectional Investigation

Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.

Community nurses＇ knowledge need toward traditional chinese medicine and related factors in China： A cross-sectional survey

Purpose：The aim of the study was to examine the knowledge need toward Traditional Chinese Medicine （TCM） in nurses who worked in Community Health Centers, and to explore the related factors in the current situation of China. Subject and setting： Participants worked in five community health centres across Chaoyang Beijing, and each com- munity health centre includes 4-7 health stations. A questionnaire survey was administered to 218 registered commu- nity nurses using cluster sampling. The investigation was conducted after obtaining informed consent from each par- ticipant. Design： A descriptive cross-sectional design was used to gather data in this study. Instruments： The survey tool was a 5-point Likert-type questionnaire designed by experts in TCM and related fields, which had good face va- lidity and internal consistency. Results： The nursing technology of TCM scored highest score in our research （42.87±5.74）. Next came disease prevention in TCM （21.02±2.67）. The lowest mean score was for the usage of Chinese herbal medicine （15.03±2.77）. The significant related factors for nurses＇ knowledge need towards TCM were educa- tional background （P 〈 0.05）, working unit （P 〈 0.01）, ＂on-the-job training on TCM＂ （P 〈 0.01） and ＂have studied lit- erature on Chinese medicine＂ （P 〈 0.05）. Conclusion： This results suggest nurses working in community care would like to learn more about TCM. Improving community nurses＇ understanding and learning of TCM can promote the application and promotion of TCM nursing technology in the community. Therefore, we could adopt targeted education for community nurses, in order to meet their knowledge needs, and to promote the application of traditional Chinese medicine knowledge to the community.