Repeatability of near visual acuity measurement at high and low contrast

Purpose: The aim of this study was to determine the repeatability of high‐ and low‐contrast visual acuity (VA) measurements at near. Methods: Fifty‐five normal subjects were recruited. Inclusion criteria included visual acuity of at least 0.00 logarithm of minimum angle of resolution (logMAR) on each eye at distance. One eye was selected for this study, either the one with a better acuity or randomly chosen if there was no difference between the two eyes. Near VA was measured in a random order with the PolyU high‐contrast (PolyU‐HC), the PolyU low‐contrast (PolyU‐LC), the Precision high‐contrast (P‐HC) and the Precision low‐contrast (P‐LC) charts at 400 mm. Measurements were repeated after one to two weeks. Repeatability was presented using the 95% limits of agreement between visits. Results: The between‐visit repeatability was ±0.063 logMAR for high‐contrast and ±0.141 for low‐contrast using the PolyU charts. The between‐visit repeatability was ±0.120 logMAR for high‐contrast and ±0.110 for low‐contrast using the Precision charts. Seventeen subjects had high‐contrast VA better than ‐0.10 logMAR using Precision chart, which could not be measured by PolyU chart. The mean difference between high‐ and low‐contrast VA was 0.108 from the Precision charts (median difference of 0.10 or one line). Conclusions: The Precision charts could measure high‐contrast near VA to threshold level. Practitioners should be aware of a VA difference of more than one line in repetitive measurement, at both high and low contrast. A difference in near high‐ and low‐contrast VA of more than one line may warrant further investigation.     

Projection of nucleus tractus solitarius units influenced by hepatoportal afferent signal to parabrachial nucleus

In urethan-chloralose anesthetized rats, units in the nucleus tractus solitarius (NTS) which antidromically responded to electrical stimulation of the parabrachial nucleus (PB) were investigated for their responses to hepatic-vagal afferent signals. Among 63 NTS units examined, 25 (40%) were excited, 17 (27%) inhibited and the remaining 21 (33%) unaffected by single shock electrical stimulation of the hepatic branch of the vagus nerve. Topical application of Na+ produced an increase in discharge rate of 9 units and a decrease in 5 units. Portal infusion of hypertonic saline produced an increase in discharge rate of 3 units and a decrease in 5 units. Furthermore, 3 units responded to both topical application of Na+ and portal infusion of hypertonic saline.     

Promoting Father Involvement for Child and Family Health

Paternal involvement in children's lives is associated with a variety of child outcomes, including improved cognition, improved mental health, reduced obesity rates, and asthma exacerbation. Given this evidence, the American Academy of Pediatrics has promoted actions by pediatricians to engage fathers in pediatric care. Despite these recommendations, the mother–child dyad, rather than the mother–father–child triad, remains a frequent focus of care. Furthermore, pediatric care is often leveraged to improve maternal health, such as screening for maternal depression, but paternal health is infrequently addressed even as men tend to exhibit riskier behaviors, poorer primary care utilization, and lower life expectancy. Therefore, increasing efforts by pediatric clinicians to engage fathers may affect the health of both father and child. These efforts to engage fathers are informed by currently used definitions and measures of father involvement, which are discussed here. Factors described in the literature that affect father involvement are also summarized, including culture and context; interpersonal factors; logistics; knowledge and self-efficacy; and attitudes, beliefs, and incentives. Innovative ways to reach fathers both in the clinic and in other settings are currently under investigation, including use of behavior change models, motivational interviewing, mobile technologies, peer support groups, and policy advocacy efforts. These modalities show promise in effectively engaging fathers and improving family health.     

A combined treatment of interferon-alpha, 8 MHz radiofrequency hyperthermia and/or irradiation in a patient with advanced renal cancer

A combined treatment of alpha interferon (INF), 8 MHz radiofrequency (RF) hyperthermia using Thermotron-RF Model 8 and/or irradiation was performed on a patient with advanced renal cancer. The patient was a 52-year-old male, who had received arterial embolization with a gelatin sponge and 60 mg of adriamycin for the right renal tumor in January, 1985. He was referred to our clinic in April, 1985. Computed tomography showed a right renal tumor, 120 x 105 x 80 mm. Histological examination revealed clear cell carcinoma of the right kidney. The tumor was unresectable because of the huge tumor size, invasion into the right lobe of the liver, multiple pulmonary metastases and severe dysproteinemia. From the beginning of May, 1985, administration of 3 x 10(6) units interferon-alpha (INF) daily and radiofrequency (RF)hyperthermia for one hour twice a week were started. By June 11, 1985, 10 sessions of RF-hyperthermia were performed. Thereafter, hyperthermia for the renal tumor was maintained once a week until June, 1986. From the middle of June, 1985, a gradual improvement of dysproteinemia and appetite loss, and a decrease of the right renal tumor size as well as disappearance of febrile attacks were attained. In November, 1985, mediastinal lymph node swelling developed. A combined therapy of RF-hyperthermia twice a week and irradiation with 2.0 Gy daily 5 times a week was started. A total of 14 sessions of RF-hyperthermia and 30 Gy of irradiation were delivered until January, 1986. Intratumoral temperature of the renal tumor reached 44.0 degrees C during the heating.(ABSTRACT TRUNCATED AT 250 WORDS)     

Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents

To test the ability of Gianturco expandable metallic stents to dilate and maintain patency in stenotic venae cavae, stenosis of the inferior vena cava was created in seven mongrel dogs by the percutaneous injection of absolute ethanol into the paravascular retroperitoneal space. Gianturco stents, placed across the stenotic segment, resulted in successful dilatation with improved hemodynamics in four dogs. The stents failed to dilate an occluded vena cava in one dog; in the remaining dogs, stent placement was complicated by early migration and occlusion. Gianturco stents were placed in two patients, one with superior vena cava syndrome and one with retroperitoneal fibrosis that obstructed the inferior vena cava, and resulted in immediate relief of presenting symptoms. These results should be viewed cautiously, but further investigation into the clinical use of the stents is indicated, especially for patients for whom other treatments are difficult.     

Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis

Although patients with risk factors for tuberculosis have increased with the increased use of immunosuppressive therapy, there have been few reports about differences in clinical findings between immunocompromised patients and nonimmunocompromised patients with pulmonary tuberculosis. Therefore, we investigated differences between the clinical features of immunocompromised patients with pulmonary tuberculosis and those of nonimmunocompromised patients in the past decade. We analyzed findings in 840 patients (312 immunocompromised and 528 nonimmunocompromised) with pulmonary tuberculosis who were found to be culture-positive for Mycobacterium tuberculosis between January 1997 and December 2006. The characteristic clinical findings of the immunocompromised patients, compared with findings in the nonimmunocompromised group, were as follows: (1) an increase in the number of patients with respiratory symptoms during the period of follow-up of underlying diseases; (2) an increase in the number of patients in a hyponutritional state and with a negative response for the tuberculin skin test; (3) an increase in the number of microbiologically smear-positive sputum specimens; (4) an increase in the number of patients with atypical radiological findings, such as a few cavities or calcification, bilateral and expansive consolidation, miliary shadows, and mediastinal and/or hilar lymphadenopathy ; (5) an increase in the number of patients with misdiagnosed pneumonia at admission; and (6) an increase in the mortality rate. We concluded that, among the immunocompromised patients with pulmonary tuberculosis, there were many patients with atypical radiological findings and with smear-positive findings for acid-fast bacilli examination that was carried out to isolate M. tuberculosis (which had become infectious). We must perform the acid-fast bacilli examination for patients who have a fever and continuous cough, and antituberculous drugs should be administered as soon as possible when the results are positive.