ABSTRACT
Purpose: To investigate the effect of high myopia and cataract surgery on the grading of diabetic retinopathy (DR) and their roles in the correlation between DR and chronic kidney disease (CKD). Methods: A total of 1,063 eyes of 1,063 diabetic patients were enrolled. We conducted binary and multiple multivariate regressions to analyze the ocular and systemic risk factors of DR. Based on the presence of myopia and history of cataract surgery, we divided the cases into four subgroups, namely those with high myopia, with the history of cataract surgery, with both conditions, and with neither, then determined the correlation between the stages of DR and CKD in each subgroup. Results: In the binary analysis, high myopia was identified as the protective factor for DR odds ratio (OR): 0.312 [95% confidence interval (CI): 0.195-0.500, p < 0.001], whereas cataract surgery was one of the independent risk factors for DR [OR: 2.818 (95% CI: 1.507-5.273), p = 0.001]. With increased stages of DR, high myopia played an increasingly protective role [mild non-proliferative DR (NPDR), OR = 0.461, p = 0.004; moderate NPDR OR = 0.217, p = 0.003; severe NPDR, OR = 0.221, p = 0.008; proliferative DR (PDR), OR = 0.125, p = 0.001], whereas cataract surgery became a stronger risk factor, especially in PDR (mild NPDR, OR = 1.595, p = 0.259; moderate NPDR, OR = 3.955, p = 0.005; severe NPDR, OR = 6.836, p < 0.001; PDR, OR = 9.756, p < 0.001). The correlation between the stages of DR and CKD in the group with neither high myopia nor cataract surgery history was the highest among all subgroups. Conclusion: High myopia was a protective factor, whereas cataract surgery is a risk factor for DR, and both factors showed stronger effects throughout the (natural disease) grading of DR. The stages of DR and CKD showed a higher correlation after adjustment of the ocular confounding factors.
ABSTRACT
Objective:To investigate the characteristics of three-dimensional high resolution anorectal manometry and the effect of biological feedback therapy on the improvement of clinical symptoms in very elderly patients with chronic functional constipation.Methods:A total of 68 cases with chronic functional constipation were divided into very elderly group(≥80 years old, n=36)and the elderly group(60-79 years old, n=32)in the retrospective analysis.Patients underwent the three-dimensional high resolution anorectal manometry before and after biological feedback therapy, and the related parameters and scores of constipation symptoms before and after treatment were compared between the two groups.Results:The results of 3D high-resolution anorectal manometry showed that the anus relaxation rate in the simulated defecation test was lower and the bowel threshold in the rectal sensory threshold test was higher in the very elderly group than in the elderly group(2.44±33.81% vs.16.34±16.99%, 103.44±42.01 ml vs.77.22±41.85 ml, t=-2.047 and 2.655, P=0.049 and 0.012). In the very elderly group, the post-biological feedback therapy versus pre-biological feedback therapy showed that anal residual pressure during simulated defecation was decreased, the absolute value of negative anorectal pressure difference was reduced and the anal relaxation rate was increased [57.50±18.88 mmHg(1 mmHg=0.133 kPa) vs.64.84±25.82 mmHg, -29.64±15.98 mmHg vs.-39.47±19.45 mmHg, 10.53±29.35% vs.2.44±33.81%, t=3.342, -4.902 and -3.209, P=0.002, 0.000 and 0.003]. The scores of clinical symptom scale showed that there was no significant difference in the effective rate between the very elderly and elderly groups(66.67% or 24/36 vs.71.88% or 23/32, χ2=0.760, P=0.860). Conclusions:The elderly functional constipation patients with defecation disorder often have rectal propulsive insufficiency and dyscoordination of pelvic floor muscle contraction.The main cause of defecation disorder in very elderly patients is the decrease of anal relaxation rate during simulated defecation.Biological feedback therapy can improve the symptoms of defecation disorder in very elderly patients by reducing the anal residual pressure during simulated defecation, increasing the anal relaxation rate and reducing the absolute value of negative anorectal pressure difference.
