Stereotactic puncture surgery combined with early hyperbaric oxygen therapy may be better for long-term functional recovery in patients with moderate amounts of thalamic-inner capsule region haemorrhage.

BACKGROUND: The prognosis of patients with thalamic hemorrhage is poor, and their long-term neurological impairment is heavy, which seriously affects their work and life.To comparatively analyse the efficacy and prognosis of patients with moderate hemorrhage in the thalamic region who underwent conservative treatment, stereotactic puncture surgery and neuroendoscopic surgery. METHOD: This study retrospectively analyzed hospitalization data from 139 adult patients with moderate-volume cerebral hemorrhage in the thalamo-endocapsular region. They were categorized into a stereotactic group (39cases), a neuroendoscopic group (36cases), and a conventional conservative group (64cases). Logistic regression analysis was used to assess risk factors for severe neurological deficits in patients. Multivariate regression modeling was used to compare the correlation of severe neurological deficits among the three groups of patients. RESULTS: Patients with thalamic moderate-volume cerebral hemorrhage had statistically significantly higher Assessment of Daily Living (ADL) scores in the stereotactic surgery group than in the conservative treatment group and the neuroendoscopic surgery group after 6 months of treatment (p< 0.001).The amount of residual hematoma was significantly lower in the surgery groups than in the conservative treatment group at 3 days, 7 days, and 2 weeks after the onset of the disease (P< 0.001).In multivariate logistic regression analyses, after adjusting for all covariates, the odds ratios for severe neurologic dysfunction in the stereotactic group and the neuroendoscopy group were, respectively, OR: 0.37 (0.12-0.87), P< 0.001 and 0.42 (0.23-1.13), P=0.361). CONCLUSION: In patients with moderate volume cerebral hemorrhage in the thalamus-inner capsule region cerebral hemorrhage, patients treated with stereotactic surgery combined with early hyperbaric oxygen therapy may have better long-term neurological recovery compared with conservative and neuroendoscopic surgical treatments.

An efficient and accurate 2D human pose estimation method using VTTransPose network.

Human pose estimation is a crucial area of study in computer vision. Transformer-based pose estimation algorithms have gained popularity for their excellent performance and relatively compact parameterization. However, these algorithms often face challenges including high computational demands and insensitivity to local details. To address these problems, the Twin attention module was introduced in TransPose to improve model efficiency and reduce resource consumption. Additionally, to address issues related to insufficient joint feature representation and poor network recognition performance, the enhanced TransPose model, named VTTransPose, replaced the basic block in the third subnet with the intra-level feature fusion module V block. The performance of the proposed VTTransPose model was validated on the public datasets COCO val2017 and COCO test-dev2017. The experimental results on COCO val2017 and COCO test-dev2017 indicate that the AP evaluation index scores of the VTTransPose network proposed are 76.5 and 73.6 respectively, marking improvements of 0.4 and 0.2 over the original TransPose network. Additionally, VTTransPose exhibited a reduction of 4.8G FLOPs, 2M parameters, and approximately 40% lower memory usage during training compared to the original TransPose model. All the experimental results demonstrate that the proposed VTTransPose is more accurate, efficient, and lightweight compared to the original TransPose model.

Stereotactic Puncture Surgery for the Treatment of Moderate Volume of Thalamus-Internal Capsule Area Hemorrhage: An Analysis of Real-World Data.

BACKGROUND: The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies. METHODS: One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the 2 groups of patients was analyzed by logistic regression analysis and model comparison. RESULTS: The primary outcome of this study was to assess the assessment of daily living scores after 6 months of treatment. Based on the analysis of this study, the assessment of daily living of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P < 0.001), and the difference was statistically significant. The amount of residual hematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days, and 2 weeks after the onset of the disease (P < 0.001), and the complication rate was lower than the conservative treatment group (P < 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (odds ratio -0.27, 95% confidence interval: 0.08-0.86, P < 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% confidence interval: 0.09-0.96, P < 0.05) after adjusting for all covariates. CONCLUSIONS: For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery.

Human Pose Estimation Based on Efficient and Lightweight High-Resolution Network (EL-HRNet).

As an important direction in computer vision, human pose estimation has received extensive attention in recent years. A High-Resolution Network (HRNet) can achieve effective estimation results as a classical human pose estimation method. However, the complex structure of the model is not conducive to deployment under limited computer resources. Therefore, an improved Efficient and Lightweight HRNet (EL-HRNet) model is proposed. In detail, point-wise and grouped convolutions were used to construct a lightweight residual module, replacing the original 3 × 3 module to reduce the parameters. To compensate for the information loss caused by the network's lightweight nature, the Convolutional Block Attention Module (CBAM) is introduced after the new lightweight residual module to construct the Lightweight Attention Basicblock (LA-Basicblock) module to achieve high-precision human pose estimation. To verify the effectiveness of the proposed EL-HRNet, experiments were carried out using the COCO2017 and MPII datasets. The experimental results show that the EL-HRNet model requires only 5 million parameters and 2.0 GFlops calculations and achieves an AP score of 67.1% on the COCO2017 validation set. In addition, PCKh@0.5mean is 87.7% on the MPII validation set, and EL-HRNet shows a good balance between model complexity and human pose estimation accuracy.

Association between high serum blood glucose lymphocyte ratio and all-cause mortality in non-traumatic cerebral hemorrhage: a retrospective analysis of the MIMIC-IV database.

Background: This study aimed to evaluate the association between the glucose-to-lymphocyte ratio (GLR) and all-cause mortality in intensive care unit (ICU) patients with Non-traumatic cerebral hemorrhage. Methods: This is a retrospective cohort study. Baseline data and in-hospital prognosis from patients with non-traumatic cerebral hemorrhage admitted to the intensive care unit. Multivariate COX regression analysis was applied and adjusted hazard ratios (HR) and 95% predictive values with confidence intervals (CI) were calculated. Survival curves for the two groups of cases were plotted using K-M curves, and subgroup analyses were performed in one step. Using restricted cubic spline curves, we analyzed the potential linear relationship between GLR and outcome indicators. Results: In the Medical Information Mart for Intensive Care IV (MIMIC-IV database), we extracted 3,783 patients with nontraumatic intracerebral hemorrhage, and 1,806 patients were finally enrolled in the study after exclusion of missing values and patients with a short hospital stay. The overall ICU mortality rate was 8.2% (148/1806) and the in-hospital mortality rate was 12.5% (225/1806). The use of curve fitting yielded a significant linear relationship between GLR and both ICU mortality and in-hospital mortality. It also suggested a reference point at GLR=3.9. These patients were categorized into high and low subgroups based on the median value of their GLR (GLR = 3.9). Model comparisons based on multivariate COX regression analysis showed that in-hospital mortality was higher in the high GLR group after adjusting for all confounders (HR = 1.31, 95% CI: 1.04-1.47), while the ICU mortality in the high GLR group was (HR = 1.73, 95% CI: 1.18-2.52). Stratified analyses based on age, gender, race, GCS, BMI, and disease type showed stable correlations between the high GLR group and in-hospital and ICU mortality. Conclusion: Based on our retrospective analysis, it is known that as the GLR increased, the in-hospital mortality rate and ICU mortality rate of patients with nontraumatic cerebral hemorrhage also increased progressively in the United States in a clear linear relationship. However, further studies are needed to confirm these findings.

IgE Epitope Analysis and Hypo-Immunoreactivity Derivative of Arginine Kinase in Mantis Shrimp (Oratosquilla oratoria).

As the main allergenic food, shrimp can trigger allergic reactions in various degrees. In this study, arginine kinase (AK) was identified as an allergen in Oratosquilla oratoria by LC-MS/MS. The open reading frame of AK was obtained, which included 356 amino acids, and recombinant AK (rAK) was expressed in Escherichia coli. The results of immunological analysis and circular dichroism showed that rAK displayed similar IgG-/IgE-binding activity and structure as native AK. Besides, five IgE linear epitopes of AK were verified by serological analysis, on the basis of which an epitope-deleted derivative was obtained and named as mAK-L. It has been shown that mAK-L displayed hypo-immunoreactivity compared to rAK, and the contents of secondary structures were different. In conclusion, these discoveries enrich the overall understanding of crustacean allergens and epitopes and set the foundations for food allergy diagnosis and immunotherapy.

Inhibition Mechanism of L-Cysteine on Maillard Reaction by Trapping 5-Hydroxymethylfurfural.

The Maillard reaction (MR) can affect the color, flavor, organoleptic properties, and nutritional value of food. Sometimes, MR is undesirable due to lowering the nutrient utilization, producing harmful neo-formed compounds, etc. In this case, it is necessary to control MR. Some chemical substances, such as phenolic acid, vitamins, aminoguanidine, and thiols extracted from garlic or onion, can effectively prevent MR. In this study, L-cysteine (L-cys) was found to inhibit MR after screening 10 sulfhydryl compounds by comparing their ability to mitigate browning. The inhibition mechanism was speculated to be related to the removal of 5-hydroxymethylfurfural (HMF), a key mid-product of MR. The reaction product of HMF and L-cys was identified and named as 1-dicysteinethioacetal-5-hydroxymethylfurfural (DCH) according to the mass spectrum and nuclear magnetic resonance spectrum of the main product. Furthermore, DCH was detected in the glutamic-fructose mixture after L-cys was added. In addition, the production of DCH also increased with the addition of L-cys. It also was worth noting that DCH showed no cell toxicity to RAW 264.7 cells. Moreover, the in vitro assays indicated that DCH had anti-inflammatory and antioxidant activities. In conclusion, L-cys inhibits MR by converting HMF into another adduct DCH with higher safety and health benefits. L-cys has the potential to be applied as an inhibitor to prevent MR during food processing and storage.

Dynamic analysis of pulmonary computed tomography (CT) characteristics in cured coronavirus disease 2019 (COVID-19) patients.

BACKGROUND: To retrospectively analyze the pulmonary computed tomography (CT) characteristics and dynamic changes in the lungs of cured coronavirus disease 2019 (COVID-19) patients at discharge and reexamination. METHODS: A total of 155 cured COVID-19 patients admitted to designated hospitals in Yunnan Province, China, from February 1, 2020, to March 20, 2020, were included. All patients underwent pulmonary CT at discharge and at 2 weeks after discharge (during reexamination at hospital). A retrospective analysis was performed using these two pulmonary CT scans of the cured patients to observe changes in the number, distribution, morphology, and density of lesions. RESULTS: At discharge, the lung CT images of 15 cured patients showed no obvious lesions, while those of the remaining 140 patients showed different degrees of residual lesions. Patients with moderate disease mostly had multiple pulmonary lesions, mainly in the lower lobes of both lungs. At reexamination, the lung lesions in the patients with moderate disease had significantly improved (P<0.05), and the lung lesions in the patients with severe disease had partially improved, especially in patients with multi-lobe involvement (χ 2 =3.956, P<0.05). At reexamination, the lung lesions of patients with severe disease did not show significant changes (P>0.05). CONCLUSIONS: The pulmonary CT manifestations of cured COVID-19 patients had certain characteristics and variation patterns, providing a reference for the clinical evaluation of treatment efficacy and prognosis of patients.

Retrograde ureteric stent insertion from percutaneous suprapubic access to the bladder in renal transplant recipients with ureteric stenosis: a novel minimally invasive technique.

BACKGROUND: Ureteric stricture is a common and salvaging complications after renal transplantation. Two treatment methods are usually used, retrograde ureteral stent placement and percutaneous nephrostomy. The former has a higher failure rate, the latter has a great risk. Therefore, a safe and reliable treatment is needed. CASE PRESENTATION: A technique of retrograde insertion of ureteral stent was established, which was applicable in three transplant recipients with post-transplant ureteral stenosis, and the data was retrospectively recorded. The patients are 2 men and 1 woman, ages 44, 27 and 32 years. These patients underwent a total of five times of retrograde insertion of ureteral stent between 2018 and 2019. None of these patients had any postoperative complication, but all patients had complete recovery from oliguric status within two weeks. CONCLUSIONS: The retrograde ureteric stent insertion by percutaneous suprapubic access to the bladder (RUS-PSAB) was demonstrated feasibility and safety in a case series with short-term follow-up. However, larger prospective studies are needed.

SGC-VSLAM: A Semantic and Geometric Constraints VSLAM for Dynamic Indoor Environments.

As one of the core technologies for autonomous mobile robots, Visual Simultaneous Localization and Mapping (VSLAM) has been widely researched in recent years. However, most state-of-the-art VSLAM adopts a strong scene rigidity assumption for analytical convenience, which limits the utility of these algorithms for real-world environments with independent dynamic objects. Hence, this paper presents a semantic and geometric constraints VSLAM (SGC-VSLAM), which is built on the RGB-D mode of ORB-SLAM2 with the addition of dynamic detection and static point cloud map construction modules. In detail, a novel improved quadtree-based method was adopted for SGC-VSLAM to enhance the performance of the feature extractor in ORB-SLAM (Oriented FAST and Rotated BRIEF-SLAM). Moreover, a new dynamic feature detection method called semantic and geometric constraints was proposed, which provided a robust and fast way to filter dynamic features. The semantic bounding box generated by YOLO v3 (You Only Look Once, v3) was used to calculate a more accurate fundamental matrix between adjacent frames, which was then used to filter all of the truly dynamic features. Finally, a static point cloud was estimated by using a new drawing key frame selection strategy. Experiments on the public TUM RGB-D (Red-Green-Blue Depth) dataset were conducted to evaluate the proposed approach. This evaluation revealed that the proposed SGC-VSLAM can effectively improve the positioning accuracy of the ORB-SLAM2 system in high-dynamic scenarios and was also able to build a map with the static parts of the real environment, which has long-term application value for autonomous mobile robots.

Inferior oblique belly transposition for V pattern strabismus.

Purpose: Monocular transposition of the inferior oblique muscle belly (IOMBT) effectively weakened mild to moderate inferior oblique overaction and corrected small primary position hypertropia. Now we aim to evaluate the efficacy of inferior oblique muscle belly transposition (IOMBT) in treating V pattern strabismus with upshoot in adduction.Methods: This is a retrospective review of 13 patients with V pattern who underwent IOMBT procedure from January 2017 to December 2018. The inclusion criteria were: the amount of V pattern from 15 to 25 pd; the degree of upshoot in adduction from +1 to +3; no or trace vertical deviation in primary gaze position. Bilateral IOMBT was performed to reduce the V pattern. Horizontal rectus muscle surgery was performed at the same stage to correct the horizontal deviation. The angle of deviation in upgaze and downgaze was measured pre- and postoperatively. The degree of elevation in adduction was graded. The amount of V pattern was the difference in horizontal angle between up- and downgaze. The change in the amount of V pattern was assessed postoperatively.Results: All 13 patients had complete resolution of the V pattern. The amount of V pattern changed from 18.92 ± 4.310 prism diopters to 3.462 ± 1.854 prism diopters postoperatively. The mean grade of upshoot in adduction changed from 1.92 to 0.12 postoperatively. No depression in adduction or consecutive A pattern were found after surgery.Conclusions: IOMBT can successfully eliminate the V pattern in patients with mild V pattern esotropia or exotropia with mild to moderate upshoot in adduction. This procedure appears to be a useful addition to our inferior oblique surgical armamentarium.

Superior oblique tendon advancement: its success as single or combined muscle treatment for selected cases of unilateral superior oblique palsy.

Purpose: To evaluate the efficacy of single or combined superior oblique tendon (SO) advancement for selected cases of unilateral superior oblique palsy (SOP).Methods: The medical records of 14 patients who underwent single or combined superior oblique tendon advancement in one institution from May 2017 to October 2018 were reviewed. All subjects with a diagnosis of unilateral SOP who underwent single or combined SO tendon advancement surgery were included. The goal of the surgery was to correct the hypertropia and head tilt. The single or combined SO tendon advancement surgery was selected based on the amount of hypertropia or head tilt and the Knapp classification of the SOP. The information recorded included pre- and postoperative deviation angle and ocular motility findings. The degree of upshoot in adduction was graded pre- and postoperatively.Results: Fourteen patients between the age of 3 and 52 years with unilateral superior oblique palsy were selected to undergo SO tendon advancement. Single SO tendon advancement was carried out in eight acquired Knapp class II or residual SOP patients. SO tendon advancement combined with contralateral inferior rectus recession was carried out in two acquired Knapp class II patients. SO tendon advancement combined with ipsilateral inferior oblique myectomy was carried out in four congenital Knapp class III patients. The changes in pre- and postoperative hypertropia at primary gaze in single SO tendon advancement patients were from 6.25 ± 2.12 prism diopters to 0.86 ± 1.46 prism diopters. The changes in degree of upshoot in adduction were from +1.86 to +0.21. Conclusions: SO tendon advancement worked well as single or combined muscle procedure to treat unilateral superior oblique palsy.

Gastric metastasis of ovarian serous cystadenocarcinoma.

BACKGROUND: Gastric metastasis from ovarian serous cystadenocarcinoma is extremely rare. CASE PRESENTATION: We herein report one case of a 45-year-old female with ovarian carcinoma who underwent cytoreductive surgery. Two years later, endoscopic ultrasonography-guided fine needle aspiration revealed gastric metastasis. The patient underwent laparoscopic resection of gastric metastases. She is currently in complete remission. CONCLUSION: Gastric metastasis from ovarian cancer should not be ignored in the clinic.

MAN1B1 is associated with poor prognosis and modulates proliferation and apoptosis in bladder cancer.

Bladder cancer (BC) has been regarded as the most common malignancy of the urinary system worldwide. With lack of investigations for molecular pathogenesis underlying that develop BC, the therapeutic efficacy of several therapeutic approaches existing is still unsatisfactory. Here, our study aimed to explore the potentially biological function of MAN1B1 on BC. In this study, MAN1B1 expression level in BC tissues and normal tissues was analyzed based on The Cancer Genome Atlas (TCGA) data and correlation between its expression and prognosis was determined using Kaplan-Meier analysis. Knockout of MAN1B1 was performed using silencing RNA and the efficacy of MAN1B1 knockout was identified using quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis. The BC cells proliferation was assessed by Cell Counting Kit-8 (CCK8) assay, and then the cells apoptosis was detected by Annexin V-fluorescein isothiocyanate (Annexin V-FITC)/propidium iodide (PI) staining and flow cytometry following MAN1B1 knocked down by small interfering RNA. Protein kinase B (AKT) signaling was evaluated by detecting related markers, namely AKT, p-AKT, 4E-BP-1 and Bax using western blot assay. As a result, the MAN1B1 expression was higher in BC tissues than those in normal tissues, besides, its overexpression was associated with poor prognosis. Moreover, MAN1B1 reduction by silencing RNA approach resulted in BC cells proliferation suppression and BC cells apoptosis promotion. Finally, AKT signaling activity was inhibited by MAN1B1 silencing. Taken together, these results unraveled that MAN1B1 may act on an oncogenic action in BC, which improved the likelihood of MAN1B1 taking on a promising prognostic biomarker and a potential target for treating BC.

Inferior Oblique Belly Transposition for Small Angle Hypertropia With Inferior Oblique Overaction: A Pilot Study.

PURPOSE: To evaluate the efficacy of transposition of the belly of the inferior oblique muscle in treating inferior oblique overaction with small angle hypertropia. METHODS: The medical records of 10 patients who underwent inferior oblique belly transposition from March 2014 to July 2016 were reviewed. Transposition of the inferior oblique muscle belly consisted of suturing the entire body of the muscle to the sclera 5 mm posterior to the temporal insertion of the inferior rectus muscle. All patients had small hypertropias (< 5 prism diopters) in the primary gaze position with associated inferior oblique overaction. Deviations in both primary and lateral gazes, compensatory face turns or head tilts, and the degree of inferior oblique overaction were evaluated preoperatively and postoperatively. RESULTS: Nine of the 10 patients had a complete resolution of inferior oblique overaction. In the remaining patient, the inferior oblique overaction improved from +3 to +1. None of the patients had any residual vertical deviation. There was elimination of compensatory head tilting in 5 patients and correction of compensatory face turns in 4 patients. One patient with mild up drifting of the involved eye also improved after the procedure. All patients expressed subjective satisfaction with the surgical outcome. CONCLUSIONS: Transposition of the inferior oblique muscle belly effectively weakened mild to moderate inferior oblique overaction and corrected small primary position hypertropias. This procedure may be a useful addition to surgical treatment options in patients with small hypertropias associated with inferior oblique overaction. [J Pediatr Ophthalmol Strabismus. 2018;55(1):43-46.].

A Multiscale Survival Process for Modeling Human Activity Patterns.

Human activity plays a central role in understanding large-scale social dynamics. It is well documented that individual activity pattern follows bursty dynamics characterized by heavy-tailed interevent time distributions. Here we study a large-scale online chatting dataset consisting of 5,549,570 users, finding that individual activity pattern varies with timescales whereas existing models only approximate empirical observations within a limited timescale. We propose a novel approach that models the intensity rate of an individual triggering an activity. We demonstrate that the model precisely captures corresponding human dynamics across multiple timescales over five orders of magnitudes. Our model also allows extracting the population heterogeneity of activity patterns, characterized by a set of individual-specific ingredients. Integrating our approach with social interactions leads to a wide range of implications.

[Treatment of large hypertropia following absence of inferior rectus by integrated anteriorization of inferior oblique combined with recession of superior rectus].

OBJECTIVE: To evaluate the effect of integrated anteriorization of inferior oblique muscle combined with recession of superior rectus to treat large hypertropia following absence of inferior rectus. METHODS: It was a retrospective case series study. Integrated anteriorization of inferior oblique muscle means transposing inferior oblique muscle 8-10 mm posterior to the insertion directly to original insertion of inferior rectus without myotomy. We reviewed 5 patients with absence of inferior rectus muscle, who treated by integrated anteriorization of inferior oblique muscle combined with recession of superior rectus. The pre and post-operative vertical deviation in primary position, ocular motility, and abnormal head position were compared. The patients were followed up from 6 to 18 months, with average as 10.8 months. RESULTS: Postoperatively, 4 patients showed orthophoria in primary position and 1 patient had 10 PD hypotropia. The infraduction deficits improved from -3.0 to -1.6. Meanwhile, there had been an average of -2.0 mild supraduction limitation. Abnormal head position (AHP) disappeared in 2 patients with AHP before operation. All the patients showed no change of cyclodeviation on fundus photograph. 5 patients were satisfied with the improvement of the appearance, and the follow-up results were stable, no other surgery again. CONCLUSIONS: Integrated anteriorization of inferior oblique muscle combined with recession of superior rectus was an effective surgical selection to treat hypertropia with absence of inferior rectus muscle. This procedure doesn't need to cut off the inferior oblique muscle. The more convenient surgical procedure can reduce the risk of bleeding.

Superior rectus transposition vs medial rectus recession for treatment of esotropic Duane syndrome.

IMPORTANCE: Superior rectus transposition (SRT) with or without medial rectus recession (MRc) has been introduced as an alternative to MRc alone for treatment of esotropic Duane syndrome; however, the effectiveness of these procedures has not been compared previously. OBJECTIVE: To compare the safety and efficacy of MRc and SRT in treatment of Duane syndrome. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of all patients with esotropic Duane syndrome who underwent surgical treatment from January 1, 2006, through December 31, 2012, in a multispecialty, hospital-based pediatric ophthalmology/adult strabismus practice at Boston Children's Hospital. Patients in the SRT group underwent SRT with or without MRc; those in the non-SRT group underwent unilateral or bilateral MRc. EXPOSURES: Surgical treatment of esotropic Duane syndrome. MAIN OUTCOMES AND MEASURES: Binocular alignment, ocular ductions, head position, stereopsis, and fundus torsion were recorded before surgery and at the 2-month and final postoperative visits. We also evaluated postoperative drift. RESULTS: The medical record review identified 36 patients who underwent 37 procedures, including 19 in the SRT group (13 SRT + MRc and 6 SRT alone) and 18 in the non-SRT group (11 unilateral MRc and 7 bilateral medial rectus resession). Mean MRc was smaller when performed with SRT (3.3 vs 5.3 mm; P = .004). Although the initial deviation was larger in the SRT group, both groups had a similar improvement in esotropia and head turn. Abduction improved by at least 1 unit in 15 of 19 patients in the SRT group (79%) vs 5 of 18 in the non-SRT group (28%). In 24 patients followed up for more than 6 months, mean esotropia decreased from 8.2 to 6.1 prism diopters (Δ) in the SRT group (n = 12) but increased from 7.2 to 10.9Δ in the non-SRT group (n = 12). CONCLUSIONS AND RELEVANCE: The combination of SRT and MRc was more effective than MRc or bilateral medial rectus resession at improving abduction while allowing for a smaller recession to align the eyes and eliminate a compensatory head posture. Although any surgery on the vertical rectus muscles should in theory increase the risk for vertical or torsional complications, to date this theory has not been borne out in our patients. Patients treated with SRT appear to have a reduced likelihood of long-term undercorrection. We therefore recommend SRT with adjustable MRc for treatment of Duane syndrome in patients with larger amounts of esotropia.

[Surgical management of anti-elevation syndrome following anterior transposition of inferior oblique muscle].

OBJECTIVE: To evaluate the effect of surgery to treat anti-elevation syndrome following anterior transposition of inferior oblique muscle (ATIO). METHODS: We retrospectively studied six cases of anti-elevation syndrome that had surgical history of anteriorization of inferior oblique muscle. We disinserted the inferior oblique from the transposed insertion and simultaneously weakened the contralateral inferior oblique for three cases with severe limited supraduction. We anteriorized the contralateral inferior oblique muscle for other three cases with mild or moderate limitation. The patients were followed up more than 6 months. RESULTS: Six cases we aged from 5 to 22 years. Postoperatively, vertical deviation in primary position improved to less than 6 PD with no more abnormal head position. Three cases with severe limited supraduction showed great improvement. All patients showed no more over reaction of contralateral inferior oblique muscle. Three cases with previously DVD showed improved drift of contralateral eye. All patients were satisfied for the correction and no more surgery were done. The results persisted after six months follow up. CONCLUSIONS: Disinserting the inferior oblique from the transposed insertion is an effective way to treat anti-elevation syndrome with severe limited supraduction. Unilateral anterization of inferior oblique should be avoided.