Abstract Myopia is a complex disease influenced by multiple factors, and its prevention and control require a thorough identification and monitoring of its risk factors. The paper examines the defocus characteristics of the visual environment and their association with myopia among children and adolescents, and further describes their role in the prevention and control of myopia, as well as analyses the limitations of the current study and proposes directions for further research. Finally, the paper calls attention to the etiological significance of the defocus characteristics in the visual environment during the development of myopia among children and adolescents, which could provide a scientific basis for optimizing the learning environment and designing other measures to promote myopia prevention and control among children and adolescents.

Objective: To explore the association between sleep quality and dry eye symptoms in adolescents,so as to provide the evidence for reducing the prevalence of dry eye symptoms. Methods: The study population was adolescents aged 12-24 years from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey, which was conducted from 20 June to 31 August 2022. A stratified random sampling and quota sampling method was used to select 6 456 adolescents within mainland China. The Ocular Surface Disease Index (OSDI) and Brief version of the Pittsburgh Sleep Quality Index (B-PSQI) were used to assess dry eye symptoms and sleep quality. Multiple Logistic regression model was used to explore the relationship between sleep quality and dry eye symptoms in adolescents. The influence of gender on the association was explored by using interaction terms. Results: A total of 2 815 adolescents reported having dry eye symptoms, with a prevalence of 43.6%. Logistic regression analysis results showed an increased risk of exacerbation of dry eye symptoms in adolescents with poor sleep quality. The OR (95% CI ) for mild, moderate, and severe dry eye symptoms groups were 1.39(1.16-1.67), 1.52(1.28-1.81), and 2.35(2.02-2.72), respectively, compared with the ocularly normal group ( P <0.05). There was a significant interaction between sleep quality and gender on dry eye symptoms in adolescents ( P <0.01). Conclusions Sleep quality is associated with dry eye symptoms in adolescents, and those with poor sleep quality have a higher risk of dry eye symptoms. The effect of sleep quality on dry eye symptoms is greater in boys.

Abstract The choroid is a multifunctional dynamic structure located between the sclera and the Bruch membrane, which may be involved in the regulation of eye growth and the development of myopia. Choroidal thickness may serve as an important biomarker for predicting the development of myopia and the effectiveness of myopia control treatments in children and adolescents. The study reviews and summarizes the physiological structure and measuring methods of the choroid, and discusses its influencing factors including age, physiological changes, refractive status, axial length, drug effects, optical environment and so on. The review points out the potential applications of choroidal thickness in myopia research among children and adolescents.

To summarize the nursing experience of 5 patients with severe ARDS complicated with hypercapnia who underwent extracorporeal carbon dioxide removal(ECCO2R).Key points of nursing care included:establishing a rapid emergency response nursing team for ECCO2R;PETCO2 real-time monitoring to grasp the timing of the machine;ensuring continuity of treatment and improving the removal efficiency;respiratory-related monitoring;prevention of complications of blood coagulation and hypothermia;and weaning from extracorporeal carbon dioxide removal.After careful treatment and care,all the 5 patients were successfully removed from ECCO2R treatment.

Objective: To understand the online learning related screen use duration and screen types in school aged children in Shanghai during the COVID-19 epidemic. Methods: Random clustering sampling was used to select 5 591 parents of students from 8 primary and junior schools that are in the sampling pool of the national myopia survey in districts of Jiading, Pudong and Baoshan in Shanghai in April 2020. Electronic questionnaire was administered to parents regarding their child s online learning related screen use. Results: On average, the median weekly duration of online learning related screen use was 13.33 hours, the curricular and extracurricular parts of which were 10(8.75，16.67) and 0(0，3.33) hours, respectively. About 29.44% of investigated school aged children only used small size screen for online learning. Children in higher grades, being myopic and parents neither being myopic were associated with reporting higher weekly duration( P <0.05); children in higher grades of primary school and parents neither being myopic were associated with a higher likelihood of using small size screen for online learning( P <0.05). Conclusion At the early stage of the COVID-19 epidemic, the burden associated with online learning related screen use was high in school aged children in Shanghai. Health education regarding online learning related screen use should be addressed in parents to guide their children to use screen appropriately.

Objective:To investigate the effect of symptom management theory(SMT)-based nursing care for the prevention of postoperative abdominal distension in patients with primary hepatocellular carcinoma.Methods:A total of 80 primary hepatocellular carcinoma patients in the Second Affiliated Hospital of Wenzhou Medical University from May 2016 to May 2019 were assigned to the experimental group and the control group according to the admission time, there were 40 cases in each group. The patients in the control group received routine postoperative nursing care, while the patients in the experimental group added SMT-based intervention. The postoperative first exhaust time and defecation time were recorded; the abdominal distension degree after 1, 3, 7 days of surgery were evaluated. In addition, the symptom distress was assessed by The Symptom Module Specific to Primary Liver Cancer (TSM-PLC).Results:The postoperative first exhaust time and defecation time were (69.08±11.44), (78.80±15.54) h in the experimental group, which were significantly lower than those in the control group (76.03±12.26), (86.03±13.48) h, the differences were statistically significant ( t=2.62, 2.22, both P<0.05). After 3, 7 days of surgery, the abdominal distension degrees were significantly alleviated in the experimental group compared to the control group, the differences were statistically significant ( Z =2.31, 2.34, both P<0.05). After 7 days of surgery, the abdominal distension, weight loss, fever symptom scores in TSM-PLC were 1.80±0.28, 0.76±0.21, 0.48±0.19 in the experimental group, which were significantly lower than those in the control group 2.16±0.31, 0.93±0.25, 0.74±0.20, the differences were statistically significant ( t=5.38, 3.27, 5.90, all P<0.05). Conclusions:SMT-based intervention can promote the recovery of postoperative gastrointestinal function and alleviate abdominal distension symptom distress of patients with primary hepatocellular carcinoma.

Objective: To explore the effect of puberty on refractive development of children and adolescents and its interaction with outdoor activities, near work and the use of electronic products, so as to provide a reference for strategies for intervening myopia. Methods: Cluster sampling method was used to select 776 students aged 7-13 from a nine year consistent school in Shanghai to participate and were followed up for 2 years. All participants underwent cycloplegic refraction and ocular axial length measurement once a year, as well as pubertal development, average daily outdoor time, near work time and time of electronic products usage. The influencing factors and interaction effects of refractive parameters in different puberty stages were analyzed by generalized estimation equation. Results: At baseline, 634 children participated in cycloplegic refraction, of which 350 were myopic (55.2%). There were significant differences in axial length, average daily outdoor time, near work time and time of using electronic products at different stages of puberty ( F = 4.10 ，4.24，5.54，9.20， P <0.05). There was interaction between puberty and outdoor time on axial length development ( β =0.133, P < 0.05), and the interaction between puberty and the time of near work or using electronic products was not statistically significant ( P >0.05). Conclusion Puberty may play a regulatory role in the relationship between outdoor time and refractive development among Chinese children and adolescents.

Abstract The prevalence of myopia among children and adolescents in China remains high. Currently, the prevention and control of myopia among children and adolescents has risen to the level of national health strategy and has attracted extensive attention from the society. Although the role of outdoor activities in preventing myopia is significant, it also has many limitations. Therefore, it is necessary to explore more effective methods for comprehensive intervention. Based on current evidence, in addition to ongoing investigatation of the role of daytime outdoor activities in myopia prevention, emerging controllable environmental and behavioral factors, e.g. increase of indoor high frequency visual information, regulation of sleep and biological rhythm and dietary supplement of polyunsaturated fatty acids ω-3, warrents further attention and active transformation into appropriate technologies for myopia prevention and control.

Objective: To analyze research hot spots and trends on myopia in children and adolescents in China, and to provide a reference for the future development of this research field. Methods: Using CiteSpace software, 725 eligible Chinese documents published over a 22 year period were sourced from CNKI, VIP and Wanfang Chinese databases, were analyzed during 2000-2021. The data were visualized by a keyword co occurrence map, and clustering, as well as burst and author cooperative networks. Results: The research field of myopia in children and adolescents in China had undergone three stages:an initial formation period, development period and rapid growth period, and it was expected that the annual number of papers will maintain an increasing trend in the future. "Myopia" "adolescents" "children" and "students" were the most frequent keywords(667, 535, 288, 47). The keyword burst "adolescents" started the earliest, and "students" had the largest burst strength and duration. Zhang Ning, Tang Wenting, Tao Fangbiao, Yang Xiao and others have made important contributions to this research field. Conclusion In recent years, the research focus in this field has gradually shifted toward the influencing factors, as well as prevention and treatment measures of child and adolescent myopia. The trend of myopia in young children and adolescents is obvious. In the future, research on the prevention, control and treatment of myopia in children and adolescents will become a hot spot.

Objective: Based on observational, longitudinal and intervention study of common diseases among students in Jiangsu Province, this paper presents the current progress of two year follow up of myopia cohort regarding the association between growth parameters with progression of myopia among children and adolescents in areas with rapid economic growth. Methods: This survey adopted the stratified cluster sampling method for school selection. The full automatic computer optometry (TOPCON RM800) was used to track myopia related parameters for all participants from 2019 to 2020 under the condition of mydriasis (compound topicamide eye drops). Relationship between growth parameters of children and adolescents and the incidence and progression of myopia was analyzed by using Cox regression multiple statistical model. Results: The myopia rates of students from grade 1 to grade 3 in 2019 were 5.4%, 21.5% and 37.3% respectively. After one year, the myopia rates of all school stages increased to 25.3%, 43.3% and 58.1% respectively( χ 2=53.59, 49.63, 32.52, P <0.01). The mean diopter of right eye and left eye after mydriasis were ( 0.30± 1.24/0.39±1.26)D in 2019 and (-0.33±1.54/-0.19±1.55)D in 2020, respectively based on Cox multiple regression results, age ( HR =1.21, 95% CI =1.09-1.34), naked eye vision ( HR =0.08, 95% CI =0.07-0.11), height ( HR =0.98, 95% CI =0.97-0.99) showed a strong correlation with the incidence and progression of myopia( P <0.05). Conclusion Myopia is growing rapidly in the central region of Jiangsu Province. It is suggested that diopter, axial length, naked eye vision, age, height and other indicators should be included in the refractive archives of children and adolescents in the region.