Ten-year refractive and visual outcomes of intraocular lens implantation in infants with congenital cataract.

INTRODUCTION: There is no consensus regarding optimal target refraction after intraocular lens implantation in infants. This study aimed to clarify relationships of initial postoperative refraction with long-term refractive and visual outcomes. METHODS: This retrospective review included 14 infants (22 eyes) who underwent unilateral or bilateral cataract extraction and primary intraocular lens implantation before the age of 1 year. All infants had ≥10 years of follow-up. RESULTS: All eyes exhibited myopic shift over a mean follow-up period of 15.9 ± 2.8 years. The greatest myopic shift occurred in the first postoperative year (mean=-5.39 ± +3.50 dioptres [D]), but smaller amounts continued beyond the tenth year (mean=-2.64 ± +2.02 D between 10 years postoperatively and last follow-up). Total myopic shift at 10 years ranged from -21.88 to -3.75 D (mean=-11.62 ± +5.14 D). Younger age at operation was correlated with larger myopic shifts at 1 year (P=0.025) and 10 years (P=0.006) postoperatively. Immediate postoperative refraction was a predictor of spherical equivalent refraction at 1 year (P=0.015) but not at 10 years (P=0.116). Immediate postoperative refraction was negatively correlated with final best-corrected visual acuity (BCVA) (P=0.018). Immediate postoperative refraction of ≥+7.00 D was correlated with worse final BCVA (P=0.029). CONCLUSION: Considerable variation in myopic shift hinders the prediction of long-term refractive outcomes in individual patients. When selecting target refraction in infants, low to moderate hyperopia (<+7.00 D) should be considered to balance the avoidance of high myopia in adulthood with the risk of worse long-term visual acuity related to high postoperative hyperopia.

Botulinum toxin as an initial therapy for management of sixth nerve palsies caused by nasopharyngeal carcinomas.

PurposeThe purpose of this study is to evaluate the efficacy and safety of botulinum toxin injection as a primary treatment for strabismus in a cohort of patients with nasopharyngeal carcinoma (NPC)-related chronic sixth nerve palsy.Patients and methodsWe retrospectively reviewed all cases of NPC-related sixth nerve palsy receiving botulinum toxin injection in the Hong Kong Eye Hospital between January 2009 and January 2016. Only cases with diplopia for at least 6 months; and failed a trial of Fresnel prism therapy were recruited. We excluded cases with prior strabismus surgery and multiple cranial nerve palsies. Patients were offered botulinum toxin injection as primary treatment for their strabismus and were given further injections or offered surgery if diplopia persisted. Success with botulinum toxin was defined as a final distant orthophoria of <15 PD in primary gaze, no diplopia in primary position, and no head turn, as measured 6 months after the last injection, without requiring a second treatment.ResultsA total of 25 patients were included in the study. All patients received concurrent chemo-radiotherapy for NPC. There was a statistically significant reduction in the mean deviation at distant after the last injection compared to that at presentation (P<0.001, Wilcoxin signed rank test). Overall, 7 patients (28%) achieved clinical success and 15 patients (64%) remained diplopia-free by repeated botulinum toxin injections alone. Nine patients went on to receive definitive surgery and all achieved good ocular alignment after surgery. Transient ptosis or vertical deviation was seen in 7 patients, which resolved within 3 months and no serious complications arose from the treatment in our series.ConclusionsBotulinum toxin injection is a relatively less-invasive alternative to surgery that can be done under a topical anesthesia setting, which improves patient's quality of life via reduction in diplopia. It is a recommendable initial option in patients with chronic nerve palsies who may have higher risks associated with strabismus surgery.

Strength training for partially paralysed muscles in people with recent spinal cord injury: a within-participant randomised controlled trial.

STUDY DESIGN: Within-participant randomised controlled trial. OBJECTIVES: To determine whether strength training combined with usual care increases strength in partially paralysed muscles of people with recent spinal cord injury (SCI) more than usual care alone. SETTINGS: SCI units in Australia and India. METHODS: Thirty people with recent SCI undergoing inpatient rehabilitation participated in this 12-week trial. One of the following muscle groups was selected as the target muscle group for each participant: the elbow flexors, elbow extensors, knee flexors or knee extensors. The target muscle on one side of the body was randomly allocated to the experimental group and the same muscle on the other side of the body was allocated to the control group. Strength training was administered to the experimental muscle but not to the control muscle. Participants were assessed at baseline and 12 weeks later. The primary outcome was maximal isometric muscle strength, and the secondary outcomes were spasticity, fatigue and participants' perception of function and strength. RESULTS: There were no dropouts, and participants received 98% of the training sessions. The mean (95% confidence interval (CI)) between-group difference for isometric strength was 4.3 Nm (1.9-6.8) with a clinically meaningful treatment effect of 2.7 Nm. The mean (95% CI) between-group difference for spasticity was 0.03/5 points (-0.25 to 0.32). CONCLUSION: Strength training increases strength in partially paralysed muscles of people with recent SCI, although it is not clear whether the size of the treatment effect is clinically meaningful. Strength training has no deleterious effects on spasticity.

Evaluation of an automatic hematology analyzer in patients with nonhematologic conditions.

The Coulter STKS is a new automated hematology analyzer that provides complete blood counts (CBCs) and a five-part white blood cell (WBC) differential count. This study evaluated its performance and determined its value in reducing the extensive manual work required to obtain WBC differential counts from patients with nonhematologic conditions. The evaluations included precision, carryover, effects of storage duration and temperature, comparison of primary (automated) and secondary (manual) methods of aspiration, comparison with the Technicon H*1 machine, and WBC differential capability. Both primary and secondary methods provided CBC values that were precise, repeatable, and satisfactory. The WBC differential results also were accurate and comparable to those obtained manually. The Coulter STKS not only precisely analyzes CBCs but also screens blood samples without WBC abnormalities, as it has a 98% predictive value of negative test results. This instrument is suitable for use in nonhematology patients in large medical centers, teaching hospitals, and general hospitals.

HLA antibodies in multiple transfused patients.

Totally 86 patients with multiple transfusions were followed up regularly for more than six months. Their sera were screened for HLA antibodies every two to four weeks. Subsequently 28 (33%) of them developed HLA antibodies. The specificities of identified antibodies were anti-A2, All, B16 and B60. However, most of the antibodies were either multiple or undetermined. The panel reactive activity (PRA) was correlated with the amount of blood components transfused. We concluded that about one third of the patients will develop HLA antibodies after multiple transfusions and the reactivity of the antibodies is correlated to the amount of blood components transfused.

Detection of antibodies to human immunodeficiency virus (HIV-1) with the particle agglutination test.

This study was designed to evaluate the sensitivity and specificity of the particle agglutination test (PA) for antibody detection and to determine whether it is possible to use this test as a screening routine for anti-human immunodeficiency virus type I antibodies instead of the enzyme linked immunosorbent assay (ELISA). Serum samples were collected from 5,142 subjects and tested with the above two tests. A total of 83 samples were observed to be ELISA-positive. However, only 36 were found to be seropositive by the PA test. These samples were then confirmed by the Western blot analysis and 28 were positive for HIV-1, 33 were negative and 22 gave indeterminate results. The most common indeterminate band was p15/17 and the p24 band came next. The sensitivity and specificity of the PA test were 100% and 99.9%. The results indicate that the PA test is not only a convenient technique but also has a high sensitivity and specificity. It can be used as a primary screening test for antibody against HIV-1 instead of the ELISA.

Evaluation of carcinoembryonic antigen, tissue polypeptide antigen, and squamous cell carcinoma antigen in the detection of cervical cancers.

Cervical cancer is a predomiannt gynecologic neoplasia in Taiwan. The associations of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and squamous cell carcinoma antigen (SCC-Ag) for detection of cervical cancers with type of cancer, clinical stage and lymph node metastasis were studied. Serum samples were collected from 395 patients with cervical cancers (61 CIN3, 334 squamous cell carcinoma, 18 adenocarcinoma), 72 patients with benign gynecologic diseases and 115 healthy controls. The sensitivities of CEA, TPA, and SCC-Ag were 15.2%, 33.6%, and 49.3%. The specificities were 89.3%, 96.2%, and 95.1%, respectively. The positive rate of CEA was found significantly higher among patients with adenocarcinoma than those with squamous cell carcinoma. The positive rate of CEA and SCC-Ag increased with advance of the clinical stages. There was no significant difference in the rate of each tumor marker between patients with lymph node metastasis and those without metastasis. The positive rate obtained by SCC-Ag alone was comparable to those by the combinations of two or three antigens. The result of the present study indicates that SCC-Ag is the most useful tumor marker in the detection of cervical cancers.

Evaluation of the effectiveness of different brands' disks in antimicrobial disk susceptibility tests.

A total of 813 routine isolates of aerobic and facultatively anaerobic bacteria were employed to determine the efficacy of different branded (Oxoid, Difco, BBL) antimicrobial disks, using disk antimicrobial susceptibility tests, for a total of 22 kinds of antimicrobial disks and 10,740 antibiotic-organism comparisons. Major positive and major negative discrepancies in results were defined as a change from "susceptible" to "both resistant", and a change from "resistant" to "both susceptible" according to the National Committee for Clinical Laboratory Standards' interpretive standards for zone diameters. Minor positive and minor negative discrepancies were defined as a change from "susceptible" to "both intermediate", or "intermediate" to "both resistant"; and a change from "resistant" to "both intermediate", or "intermediate" to "both susceptible". The overall agreements of Oxoid, Difco, and BBL systems were 98%, 98.7%, and 98.4% respectively, and their differences are not statistically significant. Different kinds of antimicrobial disks' representative patterns of these three brands are further analyzed: (A) In the Oxoid series, there were 220 discrepancies. Minor negative discrepancy is predominant, most frequently related to carbenicillin (25), gentamicin (13) and cephalothin (10). Besides minor negative discrepancy, carbenicillin also had six minor positive discrepancies. Tetracyclin had ten minor positive discrepancies. (B) In the Difco series, there were 137 discrepancies. The majority of them are minor positive discrepancies. Moxalactam (11) and cefotaxime (10) are the most common antibiotics involved. (C) In the BBL series, there were 170 discrepancies. Minor positive discrepancy was the predominant one, which mostly related to carbenicillin (24), amikacin (13), and ceftizoxime (12). In addition, tetracyclin had 24 times minor negative discrepancies. Laboratory workers must pay attention to these different patterns of representation. In order to evaluate the quality of 11 pairs of the give-away and the purchased BBL disks, we also compared the results for these 813 routine isolates (a total of 5,482 antibiotic-organism comparisons). The giveaway disks demonstrated 99.1% overall agreement with the purchased disks. There were 48 minor discrepancies [26 (0.47%) minor positive discrepancies and 22 (0.4%) minor negative discrepancies]. These results allow this study to emphasize the followings in order to raise the awareness of the laboratory workers: (i) alteration of disk efficacy during transportation and storage; (ii) major considerations in choosing different brands' antimicrobial disks, and (iii) the important roles played by salespersons and pharmaceutical companies in achieving sound results.