Detailed heart rate variability analysis in athletes.

OBJECTIVE: Heart rate variability (HRV) analysis has been used to evaluate patients with various cardiovascular diseases. While the vast majority of HRV studies have focused on pathological states, our study focuses on the less explored area of HRV analysis across different training intensity and sports. We aimed to measure HRV in healthy elite and masters athletes and compare to healthy, but non-athletic controls. METHODS: Time-domain HRV analysis was applied in 138 athletes (male 110, age 28.4 ± 8.3) and 100 controls (male 56, age 28.3 ± 6.9) during Holter monitoring (21.3 ± 3.0 h). RESULTS: All studied parameters were higher in elite athletes compared to controls [SDNN (CI) 225.3 (216.2-234.5) vs 158.6 (150.2-167.1) ms; SDNN Index (CI) 99.6 (95.6-103.7) vs 72.4 (68.7-76.2) ms; pNN50 (CI) 24.2 (22.2-26.3) vs 14.4 (12.7-16.3) %; RMSSD (CI) 71.8 (67.6-76.2) vs 50.8 (46.9-54.8) ms; p < 0.001]. Masters had higher HRV values than controls, but no significant differences were found between elite athletes and masters athletes. Some parameters were higher in canoeists-kayakers and bicyclists than runners. Lower cut-off values in elite athletes were SDNN: 147.4 ms, SDNN Index: 66.6 ms, pNN50: 9.7 %, RMSSD: 37.9 ms. INTERPRETATION: Autonomic regulation in elite athletes described with HRV is significantly different than in healthy controls. Sports modality and level of performance, but not age- or sex-influenced HRV. Our study provides athletic normal HRV values. Further investigations are needed to determine its role in risk stratification, optimization of training, or identifying overtraining.

Breech presentation: its predictors and consequences. An analysis of the Hungarian Tauffer Obstetric Database (1996-2011).

INTRODUCTION: Breech presentation is linked to abnormal pregnancy outcomes. However, the causality of this association is unknown. We aimed to investigate predictors of term breech presentation and pregnancy outcomes of breech presentation. MATERIAL AND METHODS: Using a Hungarian registry, all term (≥ 37 weeks), singleton pregnancies with cephalic, and breech presentation in 1996-2011 were analyzed (n = 41 796). Covariates were maternal medical history and data on the present pregnancy. Multivariable logistic regression was used to investigate predictors of breech presentation and of delivery (cesarean section or other obstetrical interventions at birth) and fetal outcomes (Apgar score ≤ 7, need for perinatal intensive treatment, intrauterine death or perinatal mortality) related to breech presentation. RESULTS: Breech presentation was independently associated with older maternal age, medical history (primiparity, stillbirth, spontaneous abortion, hormone treatment, and assisted reproduction), maternal morbidities (hypertension and oligohydramnios), and the fetal factors (female sex, younger gestational age at delivery, developmental abnormalities, small for gestational age, and birthweight). An adverse delivery outcome was 11.7 times (95% confidence interval 11.3-12.0) and an adverse fetal outcome was 1.39 times (95% confidence interval 1.33-1.45) more frequent in pregnancies with breech presentation compared with cephalic presentation. Further adjustment for predictors of breech presentation had no major effect on the delivery outcome, but it reduced the risk of adverse fetal outcome (odds ratio 1.18, 95% confidence interval 1.14-1.24). CONCLUSIONS: Breech presentation is a marker of pathological pregnancy and is independently associated with an increased risk of gestational complications. Closer surveillance and appropriate management of pregnancies with breech presentation is warranted to prevent adverse perinatal outcomes.

Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery.

BACKGROUND: Recently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction). METHODS: We enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days. RESULTS: Two hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p < 0.001) were associated with longer ICU stay. More than 10 days of hospital stay was associated with higher occurrence of COPD (AOR 4.56, CI: 1.95-10.67, p < 0.001), NYHA stage (AOR 6.76, CI: 2.57-17.79, p < 0.001), operation time (AOR 1.45, CI: 1.19-1.76, p < 0.001), female gender (AOR 2.16, CI: 1.06-4.40, p = 0.034) and lower self-rated health (AOR 0.63, CI: 0.41-0.99, p = 0.044). CONCLUSIONS: Lower happiness and self-rated health may influence the outcome of cardiac surgery. Therefore, these variables should be assessed in patients.

Heart rate variability is severely impaired among type 2 diabetic patients with hypertension.

INTRODUCTION: The aim of our study was to evaluate the relative effect of diabetes and hypertension on heart rate variability. RESEARCH DESIGN AND METHODS: Four age-matched groups including type 2 diabetic patients with and without hypertension, non-diabetic patients with essential hypertension and healthy control subjects were studied. Autonomic function was evaluated by the standard cardiovascular reflex tests and 24-hour heart rate variability measurement. Heart rate variability was characterized by the triangular index value and by the spectral components of the frequency domain analysis. RESULTS: According to the two-way analysis of variance on ranks, all parameters were influenced negatively by diabetes (heart rate variability triangular index: p < 0.001; low-frequency component: p < 0.0001; high-frequency component: p < 0.001; and total power: p < 0.0001), whereas hypertension had a negative effect only on the low-frequency component (p < 0.05). The interaction between hypertension and diabetes was not significant, indicating that their effects on the heart rate variability parameters are additive. Beat-to-beat variation upon deep breathing, the most sensitive cardiovascular reflex test was also negatively influenced by both diabetes (p < 0.001) and hypertension, (p < 0.05), and their effects were additive. CONCLUSIONS: Diabetes appears to have a greater effect on autonomic dysfunction compared with hypertension. Patients suffering from both diabetes and hypertension are at the highest risk of reduced heart rate variability. Early assessment of the autonomic nerve function is suggested in diabetic patients with hypertension.

A morphological study of retinal changes in unilateral amblyopia using optical coherence tomography image segmentation.

OBJECTIVE: The purpose of this study was to evaluate the possible structural changes of the macula in patients with unilateral amblyopia using optical coherence tomography (OCT) image segmentation. PATIENTS AND METHODS: 38 consecutive patients (16 male; mean age 32.4±17.6 years; range 6-67 years) with unilateral amblyopia were involved in this study. OCT examinations were performed with a time-domain OCT device, and a custom-built OCT image analysis software (OCTRIMA) was used for OCT image segmentation. The axial length (AL) was measured by a LenStar LS 900 device. Macular layer thickness, AL and manifest spherical equivalent refraction (MRSE) of the amblyopic eye were compared to that of the fellow eye. We studied if the type of amblyopia (strabismus without anisometropia, anisometropia without strabismus, strabismus with anisometropia) had any influence on macular layer thickness values. RESULTS: There was significant difference between the amblyopic and fellow eyes in MRSE and AL in all subgroups. Comparing the amblyopic and fellow eyes, we found a statistically significant difference only in the thickness of the outer nuclear layer in the central region using linear mixed model analysis keeping AL and age under control (p = 0.032). There was no significant difference in interocular difference in the thickness of any macular layers between the subgroups with one-way between-groups ANCOVA while statistically controlling for interocular difference in AL and age. CONCLUSIONS: According to our results there are subtle changes in amblyopic eyes affecting the outer nuclear layer of the fovea suggesting the possible involvement of the photoreceptors. However, further studies are warranted to support this hypothesis.

Detection of early glaucomatous progression with different parameters of the RTVue optical coherence tomograph.

PURPOSE: To investigate the ability of different parameters of the RTVue-100 Fourier-domain optical coherence tomograph (RTVue-OCT) to detect early glaucomatous progression. METHODS: One eye of 17 healthy and 51 perimetric glaucoma patients was imaged prospectively at 6-month intervals for 1.5 to 3 years. Progression was determined by Octopus normal G2 visual field progression criteria. RESULTS: Ten of the 51 glaucoma eyes progressed based on visual field criteria. Median visual field mean defect change was -0.300 dB/y for the controls, -0.120 dB/y for all glaucoma eyes (P=0.461 vs. controls), and 1.231 dB/y for the 10 functionally progressing glaucoma eyes (P<0.001 vs. controls). Ganglion cell complex (GCC), focal loss volume, and GCC global loss volume showed significantly faster rate of progression in the glaucoma group than in controls (P=0.004 and P=0.001, respectively). No optic nerve head, retinal nerve fiber layer thickness, and average GCC parameter separated the rate of progression between the groups. CONCLUSIONS: Early structural progression of glaucoma may be better detected with pattern-based GCC parameters of the RTVue-OCT than with the optic nerve head, retinal nerve fiber layer thickness or average GCC parameters of the same instrument.

Structure-function relationship between the octopus perimeter cluster mean sensitivity and sector retinal nerve fiber layer thickness measured with the RTVue optical coherence tomography and scanning laser polarimetry.

PURPOSE: To determine structure-function relationship between each of 16 Octopus perimeter G2 program clusters and the corresponding 16 peripapillary sector retinal nerve fiber layer thickness (RNFLT) values measured with the RTVue-100 Fourier-domain optical coherence tomography (RTVue OCT) and scanning laser polarimetry with variable corneal compensation (GDx-VCC) and enhanced corneal compensation (GDx-ECC) corneal compensation. METHODS: One eye of 110 white patients (15 healthy, 20 ocular hypertensive, and 75 glaucoma eyes) were investigated. The Akaike information criterion and the F test were used to identify the best fitting model. RESULTS: Parabolic relationship with logarithmic cluster mean sensitivity and linear sector RNFLT values provided the best fit. For RTVue OCT, significant (P<0.0001) coefficients of determination (R) were found for all 16 RNFLT sectors. The R values were highest for the temporal, superotemporal, and inferotemporal RNFLT sectors (0.4483 to 0.5186). For GDx-VCC/ECC, significant (P<0.01) parabolic relationship was seen for all but the temporal and nasal RNFLT sectors. The overall highest R value (0.6943) was found for a superotemporal RNFLT sector with GDx-ECC. For some RNFLT sectors, the goodness of fit differed significantly between the imaging methods. Structure-function relationship was similar for the total population and the glaucoma subgroup, whereas no relationship (P>0.05) was found for the control eyes. CONCLUSIONS: Mean sensitivity of the Octopus visual field clusters showed significant parabolic relationship with the corresponding peripapillary RNFLT sectors. The relationship was more general with the RTVue OCT than GDx-VCC or GDx-ECC. The results show that visual field clusters of the Octopus G program can be applied for detailed structure-function research.

Evaluation of continuous 24-hour intraocular pressure monitoring for assessment of prostaglandin-induced pressure reduction in glaucoma.

PURPOSE: To evaluate 24-hour continuous intraocular pressure (IOP) monitoring with a telemetric contact lens sensor (CLS) to detect prostaglandin-induced IOP reduction. METHODS: In this prospective interventional study 9 ocular hypertensive and primary open-angle glaucoma patients were washed out from IOP-lowering medication for 6 weeks. One study eye per patient underwent 3 baseline 24-hour measurement curves 4 days apart: 2 curves with Sensimed Triggerfish CLS and 1 curve with Goldmann applanation tonometry (GAT). Then the patients received travoprost monotherapy for 3 months. The 24-hour CLS and GAT curves were repeated on the study eyes under treatment at the end of the third month. RESULTS: The 24-hour GAT IOP (mean±SD) decreased from 22.91±5.11 to 18.24±2.49 mm Hg (P<0.001). In contrast, the means of the 3 CLS curves showed no significant difference (152.94, 142.35, and 132.98 au, P=0.273). No difference was seen when the SD values of the 3 CLS curves were compared (133.51, 132.18, and 110.98 au, P=0.497). All CLS curves showed an increasing time trend (P≤0.001). Correlation of all 3 CLS curves of the individual eyes was high (r=0.726), but no correlation was seen between the corresponding CLS curve periods and GAT IOP values either at baseline (r=-0.223, P=0.546) or under treatment (r=0.320, P=0.402). No difference was seen between the erect/sitting (waking) and supine (sleeping) period CLS values (P>0.05). CONCLUSIONS: Our results suggest that the current CLS technique cannot be clinically used to monitor IOP decrease induced by topical medication in glaucoma, and has limited value in identification of transient IOP elevation periods.

Accuracy of macular ganglion-cell complex thickness to total retina thickness ratio to detect glaucoma in white Europeans.

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of macular ganglion-cell complex (GCC) thickness to total retinal thickness ratio (G/T ratio), a parameter found particularly accurate in Japanese eyes to detect glaucoma and recently proposed for the RTVue-100 Fourier-domain optical coherence tomography (RTVue-100 OCT), and to compare the diagnostic accuracy of this parameter to that of parameters provided by the instrument software in European eyes. METHODS: Retinal nerve fiber layer thickness (RNFLT) and macular GCC thickness parameters of 1 randomly selected eye of 177 white European patients (50 healthy, 28 ocular hypertensive, 33 preperimetric glaucoma, and 66 perimetric glaucoma eyes) were measured with an RTVue-100 OCT. RESULTS: The RNFLT and GCC parameter values of the healthy group were significantly higher than those of the various other groups (P<0.001 for all comparisons). For all separation (normal vs. all other eyes; normal vs. preperimetric and perimetric glaucoma eyes; and normal vs. perimetric glaucoma eyes) average RNFLT, inferior RNFLT, average GCC, and inferior GCC showed consistently higher area under receiver operating characteristics curve (AUROC) than G/T ratio. In the normal versus perimetric glaucoma separation, the AUROC values were 0.977, 0.982, 0.969, 0.976, and 0.959 for average RNFLT, inferior RNFLT, average GCC, inferior GCC, and G/T ratio, respectively. CONCLUSIONS: In contrast to Japanese eyes, in white Europeans G/T ratio does not improve separation of glaucomatous and healthy eyes.

Comparison of long-term variability of retinal nerve fiber layer measurements made with the RTVue OCT and scanning laser polarimetry.

Purpose. To compare long-term variability of retinal nerve fiber layer thickness (RNFLT) measurements made with the RTVue-100 Fourier-domain optical coherence tomograph (RTVue-OCT) and scanning laser polarimetry with variable (GDx-VCC) and enhanced (GDx-ECC) corneal compensation. Methods. One eye each of 110 Caucasian patients (17 healthy, 20 ocular hypertensive, 22 preperimetric, and 51 perimetric glaucoma eyes, of which 10 showed visual field progression) were imaged prospectively at 6-month intervals for 1.5 to 3 years. Results. Median change of Octopus visual field mean defect was -0.300 dB/y for the controls, -0.120 dB/y for perimetric glaucoma group, and 1.231 dB/y for the 10 functionally progressing perimetric glaucoma eyes. Relative (%) variance of all RNFLT parameters measured with RTVue-OCT was significantly (p<<0.001) smaller than that with both of the GDx methods. Relative RNFLT progression slopes (% change/y) did not differ significantly between the methods. Relative variance of the RNFLT parameters did not differ between the control and perimetric glaucoma group with RTVue-OCT, but for most parameters it was consistently higher for perimetric glaucoma with both GDx methods (p=0.01). Relative RNFLT progression slopes, however, did not separate the control and perimetric glaucoma eyes with either method. Conclusions. Long-term RNFLT measurements are less variable with the RTVue-OCT than with GDx-VCC and GDx-ECC. Long-term measurement variability is higher in perimetric glaucoma than in healthy eyes with both GDx methods, but no similar between-group difference is seen with RTvue-OCT. None of the tested methods separated the rate of progression between healthy and well-controlled perimetric glaucoma eyes in 1.5 to 3 years follow-up.

Association of lean and fat body mass, bone biomarkers and gonadal steroids with bone mass during pre- and midpuberty.

BACKGROUND/AIMS: The association of bone mass with body composition, bone turnover markers and gonadal steroids was examined in Hungarian children during pre- and midpuberty. METHODS: Two hundred and thirty-seven 7- to 16-year-old subjects (56% girls) were investigated. Bone mineral density (BMD), fat mass and total and appendicular lean mass were estimated with dual-energy X-ray absorptiometry (Lunar Prodigy). The fat mass index and appendicular lean mass index (LMI) were calculated. Serum bone markers, parathyroid hormone, estradiol and testosterone were analyzed. Associations between variables were evaluated by multiple regression analysis. RESULTS: During prepuberty, bone biomarkers, gonadal steroids and appendicular LMI were associated with bone mass in both genders (p < 0.05). During midpuberty, girls' bone turnover markers were negatively associated with bone mass (p < 0.001). In prepuberty, appendicular LMI and ß-crosslaps were predictors of bone mass in both genders. During midpuberty, appendicular LMI and gonadal steroids positively contributed to bone mass in both genders, while osteocalcin exerted a negative influence on total and L1-L4 spine BMD in girls and on L1-L4 BMD in boys (all p < 0.001). CONCLUSIONS: Predictors for bone development varied according to Tanner stage and gender. The most significant determinants of bone mass were appendicular LMI and estradiol.

Nonpopulation-based glaucoma screening exercise in an osteoporosis patient organization: can elderly persons with advanced health awareness identify their risk for glaucoma?

PURPOSE: To investigate whether osteoporosis patient organization members with advanced health awareness can identify their risk for glaucoma. METHODS: Members of an osteoporosis patient organization group were provided with structured written information on risk factors for glaucoma. Later, the participants completed questionnaires on their risk for glaucoma (average vs. increased), demographics, trait anxiety (Trait Anxiety Inventory), health anxiety (Shortened Health Anxiety Inventory), and underwent a detailed screening for glaucoma. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation. RESULTS: The average age of 114 self-recruited White attendees (107 female and 7 male) was 70.9 years (range, 41 to 88 y). The final prevalence of glaucoma was 7.9%. Forty-three participants indicated an increased risk for glaucoma and 71 participants did not estimate his/her risk to be increased. No relationship was found between the participants' response on the glaucoma risk assessment questionnaire and presence of glaucoma (Fisher exact test, P=0.725), presence of any risk factor of glaucoma (P>0.473 for all risk factors), various sociodemographic parameters (χ test, P>0.05 for all parameters), trait anxiety (Mann-Whitney test, P=0.178), or health anxiety (P=0.204). CONCLUSIONS: Our results suggest that even when general health information and awareness training sessions are regularly given to elderly members of a nonglaucoma patient organization, self-assessment of risk for glaucoma may remain poor among the members.

Comparison of diagnostic accuracy of the RTVue Fourier-domain OCT and the GDx-VCC/ECC polarimeter to detect glaucoma.

PURPOSE: To compare sensitivity and specificity of retinal nerve fiber layer thickness (RNFLT) measurements made using RTVue-100 Fourier-domain optical coherence tomography (RTVue-OCT) and scanning laser polarimetry with variable (GDx-VCC) or enhanced compensation (GDx-ECC). METHODS: One eye of each of 177 consecutive patients was imaged. Healthy (n=50) and ocular hypertensive (n = 28) eyes were defined as structurally undamaged, preperimetric (n=33) and perimetric (n=66) glaucoma eyes as diseased. RESULTS: For average RNFLT, sensitivity was higher (χ(2) test, p=0.002) with RTVue-OCT (65.7%) than with GDx-VCC (49.5%). For superior and inferior RNFLT, sensitivity was similar with all methods. For the different nerve fiber bundle parameters, sensitivity of RTVue-OCT (64.6% to 84.8%) was consistently up to 35% higher (p<0.001) than that of GDx-VCC/ECC (28.3% to 72.7%). Specificity ranged from 84.6% to 98.7% with RTVue-OCT, 92.3% to 100% with GDx-VCC, and 94.9% to 100% with GDx-ECC, with no significant difference between the methods except for one nerve fiber bundle parameter, for which RTVue-OCT was less specific than either GDx method (p ≤ 0.004). Diagnostic accuracy of the GDx-VCC/ECC nerve fiber indicator (NFI) and RTVue-OCT average RNFLT were similar. Of the detected glaucoma cases, 87.7% were identified both by GDx-VCC/ECC NFI and average RNFLT of RTVue-OCT. CONCLUSIONS: In this clinical setting, all methods were similarly highly specific, but for localized RNFLT damage RTVue-OCT was statistically and clinically significantly more sensitive than GDx-VCC and GDx-ECC. Most detected glaucoma cases were identified with all 3 methods.

Automatic, operator-adjusted, and manual disc-definition for optic nerve head and retinal nerve fiber layer measurements with the RTVue-100 optical coherence tomograph.

PURPOSE: To evaluate the repeatability and between-methods differences of optic nerve head and retinal nerve fiber layer thickness (RNFLT) measurements as made with the automatic, operator-adjusted, and manual disc-definition functions of the RTVue-100 Fourier-domain optical coherence tomograph. METHODS: One eye of each of 126 persons (72 glaucomatous, 10 ocular hypertensive, 44 healthy control eyes) was analyzed with all 3 disc-definition functions. Thirty-three eyes were imaged 5 times for the determination of measurement repeatability. RESULTS: For several parameters, repeatability with automatic disc definition was significantly poorer than the other options. In contrast, for all but 1 parameter repeatability did not differ between the manual and operator-adjusted methods. Refractive error, disease category or peripapillary atrophy had no influence on repeatability. However, the measured values differed significantly between the methods, for all but 3 parameters. Similar between-method differences were seen for eyes irrespective of glaucoma, refractive error, or parapapillary atrophy. High intraclass correlation (93.5% to 99.9%) was seen for all parameters measured with manual and operator-adjusted methods, but in the other comparisons only for RNFLT parameters. Agreement of the classifications was better for RNFLT parameters than disc parameters, and the κ-values were highest (0.881 to 0.968) in comparing the manual and operator-adjusted methods. CONCLUSIONS: Measurement repeatability with manual and operator-adjusted disc-definition functions is similar and is not influenced by refractive error, glaucoma, or parapapillary atrophy. The high intraclass correlation and the agreement of diagnostic classifications suggest that operator-adjusted disc-definition can be useful for glaucoma detection with the RTVue-100 Fourier-domain optical coherence tomograph.

Reproducibility of retinal nerve fiber layer and macular thickness measurement with the RTVue-100 optical coherence tomograph.

PURPOSE: To evaluate the reproducibility of peripapillary retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex (GCC) measurements made with the RTVue-100 Fourier-domain optical coherence tomography (OCT) device (Optovue, Inc., Fremont, CA) and to determine the influence of 4 factors: pupil dilation, subject age, experience in imaging examinations, and glaucoma severity. DESIGN: Prospective study for evaluation of a diagnostic test. PARTICIPANTS: Thirty-seven hospital-based participants (14 normal and ocular hypertensive subjects, 11 patients with moderate and 12 with severe glaucoma), all experienced in imaging examinations, and 40 consecutive screening trial participants lacking such experience. METHODS: One eye of all participants was imaged 5 times. For the hospital-based participants, on the same day the measurement series was repeated after pupil dilation. For determination of intersession reproducibility, measurements were performed again 3 months later. MAIN OUTCOME MEASURES: Intrasession and intersession coefficient of variation (CV), intraclass correlation coefficient (ICC), intratest variability, and test-retest variability. RESULTS: For the average and quadrant RNFLT parameters and the GCC parameters, intrasession ICC varied between 93.9% and 99.0%, intrasession CV between 1.95% and 5.69%, and intratest variability varied between 3.11 and 9.13 microm. Most thickness values, all intrasession CV and intratest variability values, and the signal strength index were not changed significantly after pupil dilation. Intrasession CV of the 16 peripapillary RNFLT sectors varied between 4.90% and 11.66%. Most intrasession CV values increased significantly with increased disease severity, but intratest variability for average RNFLT and the quadrant RNFLT parameters, which are used for statistical comparison with the normative database, were unaffected by the severity of glaucoma. Patient age and experience in imaging examinations had no influence on intrasession CV. Intratest variability and intrasession CV represented 79.1% to 98.6% and 77.1% to 95.0% of test-retest variability and intervisit CV, respectively, for the average and quadrant RNFLT and the GCC parameters. CONCLUSIONS: Intrasession and intersession reproducibility of RNFLT and GCC measurements with the RTVue-100 OCT are satisfactory for diagnostic purposes, both in normals and in patients with different glaucoma severity. Pupil dilation, age, and experience in imaging examinations did not influence reproducibility in a clinically significant manner. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Influence of pupil dilation on repeatability of scanning laser polarimetry with variable and enhanced corneal compensation in different stages of glaucoma.

PURPOSE: To evaluate the influence of pupil dilation on repeatability of scanning laser polarimetry with variable (GDx-VCC) and enhanced (GDx-ECC) corneal compensation, in different stages of glaucoma. METHODS: One eye of each of 37 Caucasian participants [14 healthy and ocular hypertensive subjects with mean deviation (MD) <2 dB, 11 glaucoma patients with MD 6 to 12 dB, and 12 glaucoma patients with MD >15 dB] was imaged 5 times with both GDx-VCC and GDx-ECC, before and after pupil dilation. RESULTS: No statistically significant alteration was found for any parameter or most coefficients of variation in any group, or in the total study population, due to pupil dilation. Intraclass correlation was similar with both compensation techniques: it varied between 98.5% and 99.2% before, and 97.3% and 99.1% after pupil dilation for all participants. Intrasession variability was below 6 mum for all parameters and all groups irrespective of corneal compensation and pupil dilation. By using GDx-ECC, a statistically significant trend for higher coefficient of variation values in more severe stages of glaucoma was found, irrespective of pupil dilation (Jonckheere-Terpstra test, P<0.026, for all parameters). With GDx-VCC this trend was not seen for 2 of the 3 parameters before pupil dilation, but did appear for all parameters in mydriasis (P<0.002). CONCLUSIONS: Repeatability of GDx-VCC and GDx-ECC is similar, and is satisfactory for clinical purposes; it is only minimally influenced by pharmacological mydriasis. However, repeatability of the measurement decreases with increasing severity of glaucoma. This characteristic is better detectable with GDx-ECC than with GDx-VCC.

Comparison of repeatability of retinal nerve fiber layer thickness measurement made using the RTVue Fourier-domain optical coherence tomograph and the GDx scanning laser polarimeter with variable or enhanced corneal compensation.

PURPOSE: To compare repeatability of measurements of peripapillary retinal nerve fiber layer thickness (RNFLT) made using the RTVue-100 Fourier-domain optical coherence tomograph against repeatability of those made using scanning laser polarimetry with variable corneal compensation or enhanced corneal compensation (GDx-VCC and GDx-ECC, respectively). METHODS: One eye of each of 37 participants (14 normal and ocular hypertensive subjects, 11 patients with moderate, and 12 with severe glaucoma; groups 1, 2, and 3, respectively) was imaged using the RTVue Optic Nerve Head Map scan, GDx-VCC, and GDx-ECC, each 5 times on the same day. The coefficient of variation (CV) were compared. The P values <1% were considered as significant. RESULTS: For average RNFLT CV was significantly lower with RTVue (2.11%) than with GDx-ECC (3.22%, P=0.004), for all participants. For temporal quadrant RNFLT in all participants, and group 1, CV with RTVue (4.88% and 3.30%) was significantly lower than with GDx-ECC (7.40% and 5.88%; P=0.004), and tended to be lower than with GDx-VCC (6.81% and 5.80%; P=0.011 and 0.016, respectively). For all participants, CV for inferior quadrant RNFLT was significantly lower with RTVue (3.49%) than with GDx-VCC (5.20%, P=0.002). No other difference was seen for any other parameter in any subject group. CONCLUSIONS: Repeatability characterized by CV of RNFLT measurement with the RTVue Optic Nerve Head Map scan and GDx-VCC/GDx-ECC was similar, and sufficient for clinical purposes, both in normal subjects and in glaucoma patients with different disease severity. For average peripapillary RNFLT and temporal quadrant RNFLT, repeatability of RTVue was better than that of GDx-ECC, and tended to be better than that of GDx-VCC.

Personality traits, depression, and objectively measured adherence to once-daily prostaglandin analog medication in glaucoma.

PURPOSE: To investigate the influence of personality traits, depression, and training on objectively measured adherence to once-daily prostaglandin analog medication. METHODS: Adherence was measured with the Travalert Dosing Aid on 58 consecutive, regularly followed-up glaucoma patients already on self-administered travoprost. Before the 3-month data-collection period all patients received training on use of the device. Psychologic characteristics were measured using the State-Trait Anxiety Inventory, Eysenck Personality Questionnaire, and Beck Hopeless Scale and Depression Inventory. An adherent day was defined as travoprost instillation at 9 PM +/-2 hours. RESULTS: Adherence was 77% for the total period. Social desirability was higher than normal (U test, P<0.0001). Seven patients (12.1%) showed mild-to-moderate depression, which was not significantly associated with decreased adherence (Kruskal-Wallis test, P=0.071). Severity of glaucoma, number of ocular and systemic medications, satisfaction with the recording device, and socio-economic characteristics had no influence on adherence. CONCLUSIONS: Objectively measured adherence to once-daily prostaglandin analog medication was good, and not influenced by treatment characteristics or patient factors including mild-to-moderate depression. The elevated social desirability suggests that self-reported adherence is not a reliable measure of adherence in glaucoma.

Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations.

BACKGROUND: Blood transfusion in adults is associated with increased mortality and morbidity after cardiac operations. The aim of this study was to identify the main predictors of blood transfusion and explore the relationship between blood transfusion and adverse outcomes in a pediatric population. METHODS: We retrospectively analyzed a prospectively collected database (January 2002 to December 2003) of 657 consecutive pediatric patients undergoing open heart procedures in a tertiary pediatric cardiac center. Risk models were calculated for each blood product and for the total amount of blood transfused during the operation and in the first 24 hours. Postoperative adverse events were investigated after propensity score adjustment. RESULTS: During the postoperative period, 30 patients (4.6%) died, 80 (12.2%) sustained nonvascular pulmonary complications, and 113 (17.2%) had infection. The risk model for the total amount of blood transfusion included weight, preoperative creatinine clearance, preoperative mechanical ventilation, duration of operation and cross-clamp, surgeon, delayed chest closure, inotropic dose, and nitric oxide administration. Univariate analyses demonstrated significant associations between blood transfusion and occurrence of every complication except of neurologic events. After adjustment for propensity score and disease severity, the total amount of blood transfusion was independently associated with an increased risk for infections (odds ratio, 1.01; 95% confidence interval, 1.002 to 1.02; p = 0.01). Transfusion of platelets was associated with lower incidence of nonvascular pulmonary complications (odds ratio, 0.89; 95% confidence interval, 0.79 to 0.99; p = 0.049). CONCLUSIONS: The amount of blood transfusion is independently associated with infections but not with mortality.