RESUMO
AIM: To compare the effectiveness of network-based perception learning (NBPL) and traditional training in the treatment of amblyopia children. METHODS: This randomized controlled clinical trial recruited 56 participants aged 4-12y with anisometropic and/or strabismic amblyopia. Participants were randomly divided into two groups: the NBPL group (n=28) who received patching and NBPL for 3mo, and the control group (n=28) who got 3mo of patching and traditional training. Best-corrected visual acuity (BCVA) in the amblyopic eye and stereoacuity were measured and compared at baseline, 1, 2, and 3mo post-randomization. RESULTS: There were no significant differences in age, gender ratio, and BCVA between the two groups at baseline. At 3mo, most patients gained lines (2 logMAR lines on average) of BCVA in both groups except one 11-year-old girl in the control group (P<0.05). But no significant difference in BCVA improvement of the amblyopic eye between the two groups was found (P=0.725), and amblyopia resolved (BCVA of 0.1 logMAR or better or within 1 logMAR line of the fellow eye) for 13 (46.4%) participants in both groups. The number of patients with improvement of stereoacuity was 25 and 13 in the NBPL group and control group (P=0.041), respectively, and a significant difference exists in the distribution of stereopsis at 3mo between the two groups (P=0.015). Besides, in patients with measurable stereopsis improvement degree and space for improvement in the two groups, the NBPL group also achieved better stereoscopic improvement than the control group (10/11 vs 4/11, P<0.05). CONCLUSION: The NBPL system has a significant effect on the improvement of BCVA and stereoacuity of amblyopia children and is better than traditional training in terms of stereoacuity improvement. Perceptual learning visual training may play a more important role in the treatment of amblyopia in the future.
RESUMO
Transcatheter mitral valve replacement is increasingly being used as a treatment for high-risk patients who have native mitral valve disease; however, no comprehensive studies on its effectiveness have been reported. We therefore searched the literature for reports on patients with native mitral valve disease who underwent transcatheter access treatment. We found 40 reports, published from September 2013 through April 2017, that described the cases of 66 patients (mean age, 71 ± 12 yr; 30 women; 30 patients with mitral stenosis, 34 with mitral regurgitation, and 2 mixed) who underwent transcatheter mitral valve replacement. We documented their baseline clinical characteristics, comorbidities, diagnostic imaging results, procedural details, and postprocedural results. Access was transapical in 41 patients and transseptal in 25. The 30-day survival rate was 82.5%. The technical success rate (83.3% overall) was slightly but not significantly better in patients who had mitral regurgitation than in those who had mitral stenosis. Transapical access procedures resulted in fewer valve-in-valve implantations than did transseptal access procedures (P=0.026). These current results indicate that transcatheter mitral valve replacement is feasible in treating native mitral disease. The slightly higher technical success rate in patients who had mitral regurgitation suggests that a valve with a specific anchoring system is needed when treating mitral stenosis. Our findings indicate that transapical access is more reliable than transseptal access and that securely anchoring the valve is still challenging in transseptal access.
