The Relationship between Convergence Insufficiency and ADHD

Background: Children being evaluated for attention deficit hyperactivity disorder (ADHD) often have an eye exam as part of their evaluation. The symptoms of convergence insufficiency (CI) can make it difficult for a student to concentrate on extended reading and overlap with those of ADHD. Methods: A retrospective review of 266 patients with CI presenting to an academic pediatric ophthalmology practice was performed. All patients included were diagnosed with CI by one author (DBG) and evaluated for the diagnosis of ADHD. A computerized review was also performed looking at the converse incidence of CI in patients carrying the diagnosis of ADHD. Results: We reviewed 266 charts of patients with CI. Twenty-six patients (9.8%) were diagnosed with ADHD at some time in their clinical course. Of the patients with ADHD and CI, 20 (76.9%) were on medication for ADHD at the time of diagnosis for CI while 6 (23.1%) were either not on medication or the medication was discontinued several months before the diagnosis of CI. The review of computer records showed a 15.9% incidence of CI in the ADHD population. Conclusion: We report an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8–3.3%) (). We also note a seeming three-fold greater incidence of CI in the ADHD population. This may simply represent an association and not be a causative relationship. Until further studies are performed, however, patients diagnosed with ADHD should be evaluated to identify the small subset that may have CI – a condition that responds well to treatment at home.     

调节与辐辏因素导致视疲劳的诊断和治疗

视疲劳的临床表现复杂,因其症状的非特异性给临床诊断和病因治疗带来一定的困难.随着对该病的认识深入,发现其病因甚为复杂,并且往往是多因素混合导致发病.如果只是单纯的对症治疗效果并不理想,探寻病因进行对因治疗才是根本的治疗策略.目前已经明确多种因素可导致视疲劳,通过必要的眼科及视光学检查可确保明确且全面的病因诊断.目前针对视疲劳的病因治疗难易不同.一些病因只要去除和矫正就能避免视疲劳,而另一些就显得相对困难,调节和辐辏因素导致的视疲劳即属于后者.另一方面由于调节和辐辏检查的专科性,使得它们在视疲劳中的诊断和治疗具有一定的难度和特殊性.我们对目前调节和辐辏在视疲劳中的诊断和治疗现状进行总结,以期为临床诊治带来帮助.     

Decentralisation and convergence in health among the provinces of Spain (1980-2001)

This study measures the process of convergence in the state of health among the provinces and regions of Spain during 1980-2001 in order to analyse the possible influence of the decentralisation of healthcare management to the regions in this period. Sigma and beta convergence models, traditionally employed in macroeconomics, have been used, taking Life Expectancy at Birth (LEB) and Infant Mortality (IM) as health indicators. The analysis was carried out at two territorial levels: provinces and regions. The results reveal that the process of decentralisation either does not affect convergence or leads to divergence in health. Indeed, in the case of IM the so-called change of role scenario seems to have occurred. Thus, certain provinces with initially poor indicators have improved, overtaking those that were originally in a better position. The final result, however, is of greater dispersion than initially.     

肺结核患者生存质量评价在结核病归口管理中的临床应用

目的应用肺结核患者生命质量评价,对影响生命质量的不利因素实施干预,促进结核患者的归口管理。方法根据结核病生存质量测定专用量表的测评结果,针对影响肺结核患者生存质量的不利因素,对2008年新发现的386例疑似肺结核患者,运用自制的“流动人口肺结核患者转诊须知”与传统转诊口头讲解的方法相结合,追踪时继续围绕“转诊须知”进行健康教育等干预措施;并将干预后与干预前的转诊到位率相比较。结果2008年转诊的386例疑似肺结核患者,转诊到位286例,转诊到位率74．1％,比2007年同期相比提高20．1％,到位率提高具有统计学意义（P〈0．001）。结论应用肺结核患者生命质量评价,指导临床结核患者转诊工作,对实现（DOTS）战略和结核病“高发现率、高治愈率”起着重要的作用。     

前牙牙体聚合度的测量研究

目的通过测量60付自然恒牙列模型,获取自然前牙牙体聚合度的正常值,补充国人牙体测量方面的数据并为临床应用提供参考。方法选取山东大学在校生及青年员工的60付正常牙合牙列模型,以精细藻酸盐印模材取模,超硬石膏灌注,对模型各前牙进行定点,转移模型各定点至坐标纸,测量、计算颊舌向聚合度,统计分析所得数据。结果得出各牙位牙体颊舌向聚合度。结论本研究的前牙牙体聚合度测量补充了牙体测量方面的科学数据。对较大聚合度牙齿牙体预备时,先预备牙合面可减少磨切量,对保护牙体有重要意义。     

Dependence of short-latency ocular following and associated activity in the medial superior temporal area (MST) on ocular vergence

Motion of a large-field pattern elicits short-latency ocular following responses (OFR) in the monkey, which are mediated at least in part by the medial superior temporal area of the cortex (MST). The magnitude of the OFR is known to be inversely related to viewing distance, and we investigated the dependence of OFR and the associated neuronal activity in the MST on a major cue to viewing distance, ocular vergence, in alert monkeys (Macaca fuscata). The vergence angle, expressed in terms of the apparent viewing distance, ranged from infinity to 16.6 cm (0–6 m⁻¹). The magnitude of the initial OFR increased monotonically with increases in convergence at a mean (±SD) rate of 19.6±4.5%/m⁻¹ in four monkeys (over the range 0–4 m⁻¹). In two monkeys, we recorded the single unit activity of 160 MST neurons that responded to motion of a large-field pattern with directional selectivity. The mean latency (±SD) of the MST discharges elicited by large-field motion was 50±7.5 ms (n=115), which preceded the onset of OFR by an average of 10±9.9 ms. The discharge modulation elicited by large-field motion showed a significant dependence on vergence in 91/160 neurons (57%), 72 of which (79%) increased their firing rate with increasing convergence (“near” neurons), and the remainder increasing their firing rate with decreasing convergence (“far” neurons). However, on average, the sensivity of these MST neurons to vergence was only about 30% of that shown by the OFR. It could be that only those neurons that are very sensitive to vergence angle contribute to the OFR, but it is also possible that much of the modulation of OFR with vergence occurs downstream from the MST or in alternative pathways (yet to be discovered) that contribute to OFR. Received: 11 October 1997 / Accepted: 21 January 1998     

Otolith and canal integration on single vestibular neurons in cats

In this review, based primarily on work from our laboratory, but related to previous studies, we summarize what is known about the convergence of vestibular afferent inputs onto single vestibular neurons activated by selective stimulation of individual vestibular nerve branches. Horizontal semicircular canal (HC), anterior semicircular canal (AC), posterior semicircular canal (PC), utricular (UT), and saccular (SAC) nerves were selectively stimulated in decerebrate cats. All recorded neurons were classified as either projection neurons, which consisted of vestibulospinal (VS), vestibulo-oculospinal (VOS), vestibulo-ocular (VO) neurons, or non-projection neurons, which we simply term vestibular (V) neurons. The first three types could be successfully activated antidromically from oculomotor/trochlear nuclei and/or spinal cord, and the last type could not be activated antidromically from either site. A total of 1228 neurons were activated by stimulation of various nerve pair combinations. Convergent neurons were located in the caudoventral part of the lateral, the rostral part of the descending, and the medial vestibular nuclei. Otolith-activated vestibular neurons in the superior vestibular nucleus were extremely rare. A high percentage of neurons received excitatory inputs from two nerve pairs, a small percentage received reciprocal convergent inputs and even fewer received inhibitory inputs from both nerves. More than 30% of vestibular neurons received convergent inputs from vertical semicircular canal/otolith nerve pairs. In contrast, only half as many received convergent inputs from HC/otolith-nerve pairs, implying that convergent input from vertical semicircular canal and otolith-nerve pairs may play a more important role than that played by inputs from horizontal semicircular canal and otolith-nerve pairs. Convergent VS neurons projected through the ipsilateral lateral vestibulospinal tract (i-LVST) and the medial vestibulospinal tract (MVST). Almost all the VOS neurons projected through the MVST. Convergent neurons projecting to the oculomotor/trochlear nuclei were much fewer in number than those projecting to the spinal cord. Some of the convergent neurons that receive both canal and otolith input may contribute to the short-latency pathway of the vestibulocollic reflex. The functional significance of these convergences is discussed.     

Synaptic input to cells of the rabbit superior cervical ganglion

Orthodromic responses in rabbit superior cervical ganglion (s.c.g.) cells were investigated in vitro with intracellular electrodes. Mean RMP was-55.4±0.8 mV, mean input resistance 39.7±1.9 M and membrane time constant 10.8±0.7 ms.Several distinct patterns of orthodromic response consisting of synaptic potentials of different latencies and the generation of 1–3 orthodromic action potentials were observed. In one of these, stimulation of higher threshold preganglionic fibres evoked an orthodronic action potential of longer latency, in another of shorter latency. Marked convergence of preganglionic fibres onto ganglion cells occurred; on average a minimum of 7.5±0.4 fibres converged on each cell. Of 29 cells, 24 (i.e. 83%) received an input from both low threshold (B) and high threshold (C) fibres. In 15 of these cells a single action potential was generated, in 14 of these cells 2 or more action potentials were generated during the orthodromic response. The physiological significance of this convergence and its implications for the extent of divergence at this synapse are discussed; on average each preganglionic axon must synapse 240 ganglion cells.Some observations on the occurrence of IS action potentials on direct stimulation of the cell and on the conductance change during the after-hyperpolarization following the action potential are also reported.     

北京市宣武区肺结核病人归口管理的探讨

目的 评价宣武区五年来肺结核病人归口管理的做法及成效。方法 建立归口管理制度,定期抽查综合医院诊断记录、入院登记、报告记录,通过对疫情报告卡片追访核实,掌握漏报、确诊、转诊到位及截留病人情况。结果 抽查漏报率为0.4%～2.0%;转诊到位率为75.0%～86.1%;截留率为23.3%～10.1%。结论 疫情报告逐年好转,转诊到位率逐年提高,截留率下降,截留病例90%以上为结核性胸膜炎。     

深圳市属医院肺结核归口管理检查结果分析

目的　调查综合医院肺结核归口管理工作的现状,掌握可疑肺结核病人报告转诊的实际情况,采取有效措施提高病人发现水平。方法 调查4家市属医院,检查相关部门的资料。结果 综合医院存在漏诊和转诊不到位的情况。结论 采取有效的措施,提高病人的转诊到位率。