Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study

Scand J Caring Sci; 2013; 27; 13–19 Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study Objective: This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Design: Prospective and longitudinal study. Subjects: 190 old women and men participated, of whom 56 could be included in the 5‐year follow‐up. Methods: The mean SOC score from the first and second data collection were compared using a paired sample t‐test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Main outcome measures: Antonovsky’s SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. Result: For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow‐up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. Conclusion: We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.     

Clinical features of posterior microphthalmic and nanophthalmic eyes

AIM: To clinically differentiate nanophthalmos (NO) and posterior microphthalmos (PM) and to explore the mechanisms related to papillomacular folds (PMF). METHODS: Medical records of 34 unrelated patients with microphthalmos (54 eyes) from April 2009 to October 2017 were retrospectively reviewed. RESULTS: Fourteen eyes of 7 unrelated patients with NO and PM were included in the study. The presenting age of the NO cohort was significantly higher compared with the PM cohort (NO: 27±16y; PM: 3.7±0.6y). PMF was more likely to occur in cases with PM than in NO (25% in NO, 100% in PM). The anatomic features of PMF from optical coherence tomography (OCT) included: ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and outer nuclear layer. In eyes without an apparent PMF (these were all NO eyes), rudimentary fovea without a foveal pit was noted. Four eyes that were NO developed angle closure glaucoma. Three NO eyes developed exudative retinal detachment and were successfully treated with lamellar sclerectomy. CONCLUSION: Posterior segment changes are pervasive both in PM and NO. Complications like angle closure glaucoma and exudative retinal detachment are likely to occur in eyes with NO but not with PM. Detailed OCT analysis found that PMF was partially a neural retinal issue, suggesting that redundancy of retinal issues involved only inner retinal layers.     

高度近视合并青光眼患者视神经纤维层厚度的变化

目的:通过光学相干断层成像(OCT)检测高度近视合并青光眼患者视神经纤维层厚度的变化规律。方法:选取2017-01/12于我院进行治疗的高度近视合并青光眼患者80例160眼作为观察组,并选择同期于我院进行体检的健康志愿者60例120眼作为对照组。采用OCT分析所有受检者视神经纤维层厚度。结果:与对照组受检者相比,观察组患者鼻侧、颞上、鼻下、鼻上、颞下及全周平均视神经纤维层厚度均降低,而颞侧视神经纤维层厚度升高(P<0.05),且观察组中屈光度-10.00^-11.00D的患者鼻侧、颞上、鼻下、鼻上、颞下及全周平均视神经纤维层厚度均显著高于屈光度≥-12.00D的患者(P<0.05)。Spearman相关分析结果显示,观察组患者屈光度的绝对值与鼻侧、颞上、鼻下、颞下及全周平均厚度视神经纤维层厚度呈负相关,与颞侧视神经纤维层厚度呈正相关。结论:高度近视合并青光眼患者除颞侧外各象限视神经纤维层变薄。     

The “silent” imprint of musical training

Playing a musical instrument at a professional level is a complex multimodal task requiring information integration between different brain regions supporting auditory, somatosensory, motor, and cognitive functions. These kinds of task‐specific activations are known to have a profound influence on both the functional and structural architecture of the human brain. However, until now, it is widely unknown whether this specific imprint of musical practice can still be detected during rest when no musical instrument is used. Therefore, we applied high‐density electroencephalography and evaluated whole‐brain functional connectivity as well as small‐world topologies (i.e., node degree) during resting state in a sample of 15 professional musicians and 15 nonmusicians. As expected, musicians demonstrate increased intra‐ and interhemispheric functional connectivity between those brain regions that are typically involved in music perception and production, such as the auditory, the sensorimotor, and prefrontal cortex as well as Broca's area. In addition, mean connectivity within this specific network was positively related to musical skill and the total number of training hours. Thus, we conclude that musical training distinctively shapes intrinsic functional network characteristics in such a manner that its signature can still be detected during a task‐free condition. Hum Brain Mapp 37:536–546, 2016. © 2015 Wiley Periodicals, Inc.     

Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning

PurposeTo assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL).MethodsRetrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n = 100); Group 2, partial SRF resorption (n = 66); and Group 3, absence of any SRF resorption (n = 50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1 vs. 2 and 3 together; 3rd compares groups 2 vs. 3.ResultsThe mean age was 55.6 ± 10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529 ± 0.035. In the second model, the mean accuracy was higher (0.670 ± 0.046). In the third approach, the algorithm showed a precision of 0.74 ± 0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69 ± 0.15 in group 3 (absence of SRF resolution).ConclusionDespite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.     

光学相干断层扫描血管成像对玻璃体腔注射雷珠单抗治疗湿性年龄相关性黄斑变性的随访观察

目的 利用光学相干断层扫描血管成像(OCTA)观察雷珠单抗玻璃体腔注射3次+必要时(3+PRN)方案治疗湿性年龄相关性黄斑变性(AMD)的图像特征。方法 选取2016年9月至2017年5月经荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)检查确诊且未予治疗的湿性AMD患者8例8只眼,按照3+PRN治疗方案给予玻璃体腔注射雷珠单抗(0.5 mg/0.05 ml)治疗,采用OCTA 6 mm×6 mm范围模式扫描黄斑区视网膜,在患者治疗前,治疗后1、3、6个月进行规律的门诊随访,记录患者最小分辨角对数(logMAR)矫正视力、脉络膜新生血管(CNV)分型、CNV形态特征及变化、黄斑中心凹视网膜厚度(CRT)、黄斑区视网膜外层血流密度(ORVD)及脉络膜毛细血管层血流密度(CCVD)。结果 男性4例4只眼,女性4例4只眼,平均年龄(70.9±10.6)岁;3只眼为Ⅰ型CNV,5只眼为Ⅱ型CNV。治疗前,治疗后1、3、6个月最佳矫正视力(BCVA)分别为0.55(0.33,0.87)、0.35(0.24,0.84)、0.35(0.22,0.58)、0.26(0.10,0.58)logMAR,各组间差异均无统计学意义(P均>0.05);CRT分别为(271.88±91.95)、(204.00±45.78)、(196.00±31.14)、(219.25±71.32)μm,其中,治疗3个月与治疗前差异有统计学意义(t=2.211,P=0.044);ORVD分别为(41.38±2.77)%、(41.73±3.60)%、(42.53±1.95)%、(41.40±2.33)%,各组间差异均无统计学意义(P均>0.05);CCVD分别为(64.38±2.24)%、(64.96±1.39)%、(64.16±1.39)%、(64.63±1.86)%,各组间差异也均无统计学意义(P均>0.05)。相关性分析结果显示,BCVA与CRT(P=0.009, RR=0.457)和CCVD(P=0.001,RR=0.574)显著相关,与ORVD(P=0.093,RR=0.302)不相关。治疗前CNV形态特征,2只眼为团状,2只眼为线条样,2只眼为纠缠错乱状,1只眼为椭圆环形,1只眼为碎片样。治疗1个月,7只眼CNV形态趋于正常化,表现为CNV最大直径减小、断裂/破碎、周边毛细血管丢失、数量和密度下降、所在区域最大横截面积减小;1只眼CNV形态较前恶化,表现为CNV吻合成环、密度增加、最大血管直径增加。治疗3个月,7只眼CNV形态趋于正常化,1只眼较前无明显变化。治疗6个月,5只眼CNV趋于正常化,3只眼恶化。随访中未发现眼内感染或玻璃体内注射的其他并发症。结论 利用OCTA技术观察CNV特征能够评估湿性AMD患者接受雷珠单抗治疗的疗效,可为湿性AMD患者的治疗与随访提供指导。     

冠状动脉钙化病变识别与评估进展

冠状动脉钙化（CAC）在很多复杂性冠状动脉病变中都有所涉及,使得经皮冠状动脉介入治疗（PCI）难度大大增加,给心脏介入临床带来了很大的挑战。而预先准确评估冠状动脉的钙化病变对于后续治疗有着至关重要的影响。近年来,随着医学领域对冠状动脉钙化病变研究的不断深入,在临床中可以通过许多其他针对冠脉的检查,来帮助完成对钙化病变的预先评估,从而规避了介入治疗的风险,改善了介入治疗的预后。本文分别从冠状动脉计算机断层扫描（computed tomography angiography,CTA）、冠状动脉造影（coronary angiography,CAG）、冠状动脉血管内超声（intravascular ultrasound,IVUS）及光学相干成像（optical coherence tomography,OCT）4种临床常用辅助检查的角度,详细分析各种技术手段所存在优势与不足,并强调在实际临床工作中,我们需要将无创手段与冠状动脉造影相结合完善冠状动脉钙化病变介入治疗。