Positional accommodative intraocular lens power error induced by the estimation of the corneal power and the effective lens position

Purpose:

To evaluate the predictability of the refractive correction achieved with a positional accommodating intraocular lenses (IOL) and to develop a potential optimization of it by minimizing the error associated with the keratometric estimation of the corneal power and by developing a predictive formula for the effective lens position (ELP).

Materials and Methods:

Clinical data from 25 eyes of 14 patients (age range, 52–77 years) and undergoing cataract surgery with implantation of the accommodating IOL Crystalens HD (Bausch and Lomb) were retrospectively reviewed. In all cases, the calculation of an adjusted IOL power (P_IOLadj) based on Gaussian optics considering the residual refractive error was done using a variable keratometric index value (n_kadj) for corneal power estimation with and without using an estimation algorithm for ELP obtained by multiple regression analysis (ELP_adj). P_IOLadj was compared to the real IOL power implanted (P_IOLReal, calculated with the SRK-T formula) and also to the values estimated by the Haigis, HofferQ, and Holladay I formulas.

Results:

No statistically significant differences were found between P_IOLReal and P_IOLadj when ELP_adj was used (P = 0.10), with a range of agreement between calculations of 1.23 D. In contrast, P_IOLReal was significantly higher when compared to P_IOLadj without using ELP_adj and also compared to the values estimated by the other formulas.

Conclusions:

Predictable refractive outcomes can be obtained with the accommodating IOL Crystalens HD using a variable keratometric index for corneal power estimation and by estimating ELP with an algorithm dependent on anatomical factors and age.     

The role of muscle proprioceptors in human limb position sense: a hypothesis

In this mini-review I have proposed that there are two kinds of position sense, one a sense of the position of one part of the body relative to another, the other a sense of the location in space of our body and its limbs. A common method used to measure position sense is to ask subjects to match with one arm the position adopted by the other. Here all of the evidence points to muscle spindles as the major proprioceptors, with cutaneous receptors acting as proprioceptors providing a supporting role. Other senses such as vision do not play a major role. The sense of localisation in space measured by pointing to the arm, rather than matching its position, I propose, is not served by proprioceptors but by exteroceptors, vision, touch and hearing. Here the afferent input is relayed to sensory areas of the brain, to address the postural schema, a cortical map of the body and limbs, specifying its size and shape. It is here that spatial location is computed. This novel interpretation of position sense as two separate entities has the advantage of proposing new, future experiments and if it is supported by the findings, it will represent an important step forward in our understanding of the central processing of spatial information.     

利用品管圈活动提高脑卒中偏瘫患者良肢位使用率

【】 目的: 探讨利用“品管圈”活动提高脑卒中偏瘫患者良肢位的使用率,促进偏瘫患者康复。方法: 成立“品管圈”小组,对脑卒中偏瘫患者良肢位执行不力的原因进行要因分析,提出目标,制定改进措施,开展活动。结果: 偏瘫患者良肢位使用率由活动前的21%提高至活动后的90%,差异有统计学意义( P ＜ 0． 05) ,护理质量得到持续改进。结论: 品管圈活动可有效提高脑卒中偏瘫患者良肢位的使用率,对患者的早期康复具有十分重要的意义。     

微创另路挂线术治疗高位蹄形肛瘘的临床效果观察

目的：观察微创另路挂线术治疗高位蹄形肛瘘的临床效果。方法将高位蹄形肛瘘患者76例,按照随机数字表法分为微创组与对照组,每组38例,微创组行微创另路挂线术治疗,对照组行常规的弧形切开引流术。对比两组术中出血量、手术时间、切口愈合时间、术后肛门外括约肌肌电图、肛门功能、疼痛积分、肛门渗液积分、肛门狭窄程度积分、肛门失禁积分。结果微创组术后肛门外括约肌收缩波幅、静息波幅均高于对照组（P均＜0．05）,肛门外括约肌肌电时程低于对照组（P＜0．05）,术后6 d疼痛积分、肛门渗液积分少于对照组（P＜0．05）,两组术后肛门狭窄程度积分、肛门失禁积分与对照组比较,差异无统计学意义（ P＞0．05）。结论微创另路挂线术治疗高位蹄形肛瘘效果好,创伤小,能有效保护肛周组织,促进肛门功能恢复。     

Investigation of vibration‐induced artifact in clinical diffusion‐weighted imaging of pediatric subjects

It has been reported that mechanical vibrations of the magnetic resonance imaging scanner could produce spurious signal dropouts in diffusion‐weighted images resulting in artifactual anisotropy in certain regions of the brain with red appearance in the Directionally Encoded Color maps. We performed a review of the frequency of this artifact across pediatric studies, noting differences by scanner manufacturer, acquisition protocol, as well as weight and position of the subject. We also evaluated the ability of automated and quantitative methods to detect this artifact. We found that the artifact may be present in over 50% of data in certain protocols and is not limited to one scanner manufacturer. While a specific scanner had the highest incidence, low body weight and positioning were also associated with appearance of the artifact for both scanner types evaluated, making children potentially more susceptible than adults. Visual inspection remains the best method for artifact identification. Software for automated detection showed very low sensitivity (10%). The artifact may present inconsistently in longitudinal studies. We discuss a published case report that has been widely cited and used as evidence to set policy about diagnostic criteria for determining vegetative state. That report attributed longitudinal changes in anisotropy to white matter plasticity without considering the possibility that the changes were caused by this artifact. Our study underscores the need to check for the presence of this artifact in clinical studies, analyzes circumstances for when it may be more likely to occur, and suggests simple strategies to identify and potentially avoid its effects. Hum Brain Mapp 36:4745–4757, 2015. © 2015 Wiley Periodicals, Inc.     

甲状腺手术患者术前枕位训练对减少颈部不适的作用

目的探讨术前枕位训练对甲状腺手术患者颈部不适的作用。方法选择2013年4月~2014年7月我院行甲状腺手术的患者124例,按照入院顺序分为对照组56例和实验组68例。对照组术前给予常规护理。实验组在术前常规护理的基础上实施枕位训练指导。比较两组术中体位不适的评定结果、术后48h发生不适情况及住院时间、满意度。结果两组术中体位不适评定结果比较有显著性差异(P0.05);两组术后48h颈僵、头痛头晕、恶心呕吐、活动受限发生率比较,有显著性差异(P0.05)。两组满意度、住院时间比较有显著性差异(P0.05)。结论术前体位适应性训练可有效减少或减轻术中及术后头痛、呕吐等甲状腺手术体位综合征的症状,降低手术的风险,缩短手术时间,减轻患者痛苦,提高患者术后生活质量。     

Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation

Purpose

To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation.

Materials and Methods

All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation.

Results

Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513].

Conclusion

Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.     

Women's status within the household as a determinant of maternal health care use in Nigeria

BackgroundAlthough gender inequality is often cited as a barrier to improving maternal health in sub-saharan Africa, there is lack of empirical data on how women''s socio-cultural characteristics may influence use of health services in Nigeria.ObjectiveTo describe how women''s position in the household affects receipt of maternity care services.MethodsSecondary data analysis of 10,052 and 4,590 currently married women aged 15 to 49 years from the 2008 Nigerian DHS who receive skilled antenatal and delivery care at least till pregnancy was done.ResultsReceipt of skilled delivery care was by 37.9% while, natal care was by 98.4%. Education, residence and wealth index all significantly influenced receipt of maternal health care. Women who were involved in decision making on their own health (aOR=1.97; 95%CI=1.88–2.06) and were employed throughout the year (aOR=1.11; 95%CI=1.01–1.23) were more likely to receive skilled antenatal care, while those who justified physical intimate partner violence were less likely to receive both skilled antenatal care (aOR=0.92; 95%CI=0.85–0.98) and delivery services (aOR 0.54; 95% CI 0.33–0.87).ConclusionInterventions aimed at improving maternal care should promote women empowerment (decision making, self worth, educational and economic) and should involve partners.     

对86例寒湿凝滞证原发性痛经患者不同子宫位置与三阴交穴效应关系的分析

目的通过对一项针刺治疗寒湿凝滞证原发性痛经的临床试验的相关数据进行分析,探讨寒湿凝滞证原发性痛经子宫位置与三阴交穴效应的关系。方法按照中央完全随机方案将96例寒湿凝滞证原发性痛经患者随机均等分为期望得气组和期望不得气组,排除子宫位置资料不全者最终纳入86例,于治疗前通过超声对每位受试者子宫位置进行评估,当疼痛视觉模拟量表(VAS-P)值≥40 mm时,取双侧三阴交穴,期望得气组以Φ0.3×40 mm一次性无菌管针直刺1~1.2寸,每10分钟行平补平泻手法30秒;期望不得气组以Φ0.18×13 mm一次性无菌管针弹入即可,不施手法,两组均留针30分钟后缓慢平和的将针渐渐退出,进行疗效检测。采用疼痛视觉模拟评分量表(VAS-P)值评价两组治疗前、起针即刻(针刺30分钟)和起针后10分钟(40分钟)的疼痛情况。并比较各子宫位置反应者比例(治疗前后VAS-P值降低50%及以上患者的比例)、总体有效率、起针即刻效应(治疗前VAS-P值-起针即刻VAS-P值)与起针后效应(治疗前VAS-P值-起针后10分钟VAS-P值)。数据采用重复测量的方差分析、卡方检验、单因素方差分析或非参数检验。结果不同子宫位置间治疗前后各时点VAS-P值、反应者率、总体有效率、起针即刻效应与后效应比较均无显著统计学差异(P≥0.05)。结论现有统计结果提示子宫位置可能与三阴交穴效应无关,其结果有待于前瞻性临床随机对照试验的证实。