Comparison of excyclotorsion following graded inferior oblique recession for primary versus secondary inferior oblique overaction

AIM:To compare the changes in excyclotorsion after inferior oblique(IO)recession in patients with primary and secondary inferior oblique overaction(IOOA).METHODS:We retrospectively analyzed the data obtained from patients with IOOA who underwent graded IO recession.The patients were followed up for at least 3 mo after surgery.Fundus photographs were taken preand postoperatively,and the sum of the angles of torsion in both eyes was used to analyze changes in excyclotorsion.Patients were divided into two groups:those diagnosed with primary IOOA were enrolled in the 1’IOOA group,and those diagnosed with secondary IOOA caused by superior oblique palsy(SOP)were enrolled in the 2’IOOA group.Excyclotorsion before and after surgery were compared between the two groups.RESULTS:A total of 78 patients were enrolled in this study:34 eyes in the 1’IOOA group and 44 eyes in the 2’IOOA group.In the 78 patients,torsional angle significantly decreased from 15.31°±7.40°to 12.11°±6.53°after IO recession(P<0.001).Mean preoperative torsional angle was larger in the 2’IOOA group than in the 1’IOOA group(P=0.03).In both groups,excyclotorsion significantly decreased after IO recession(P=0.001 and P<0.001,respectively);however,there was no significant difference in the amounts of changes in excyclotorsion between the two groups.CONCLUSION:Excyclotorsion is significantly larger in secondary IOOA than in primary IOOA,and a significant decrease in the torsional angle occurs after IO recession in both types of IOOA.

Multiple cranial nerve palsies with small angle exotropia following COVID-19 mRNA vaccination in an adolescent:A case report

BACKGROUND Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed,raising public concerns regarding the side effects of immunization,as the incidence of ease.Although many adverse events following the coronavirus disease 2019(COVID-19)vaccine have been reported,neurological complications are relatively uncommon.Herein,we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient.CASE SUMMARY A previously healthy,14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead,and pain in the right cheek.She had received second dose of the COVID-19 mRNA vaccine(Pfizer-BioNTech)18 days before onset of symptoms.She was diagnosed with Bell’s palsy and prescribed a steroid(1 mg/kg/day methylprednisolone)based on symptoms and magnetic resonance imaging findings.However,the next day,all sense of taste was lost with inability to swallow solid food;the gag reflex was absent.Horizontal diplopia was also present.Due to worsening of her condition,she was given high-dose steroids(1g/day methylprednisolone)for 3 days and then discharged with oral steroids.Improvement in the symptoms was noted 4 days post steroid treatment completion.At the most recent follow-up,her general condition was good with no symptoms except diplopia;ocular motility disturbances were noted.Hence,prism glasses were prescribed for diplopia relief.CONCLUSION Small-angle exotropia was observed in the facial,trigeminal,and glossopharyngeal nerve palsies,in our patient.The etiology of this adverse effect following vaccination was thought to be immunological.

Mechanical characteristics of tensile strength ratio method compared to other parameters used for moisture susceptibility evaluation of asphalt mixtures

In this study,mechanical characteristics of tensile strength ratio(TSR)were evaluated by comparing it to other methods in evaluating moisture sensitivity of asphalt mixtures.Twenty types of asphalt mixtures with and without anti-stripping additives were prepared and tested in the laboratory.Uniaxial compressive strength(UCS)and indirect tensile(IDT)testing were conducted to determine the mixture’s tensile strength ratio and cohesion ratio(CR).Determining TSR alone was found to be insufficient when evaluating moisture resistance.There is a need to consider both TSR and wet IDT strength to properly evaluate moisture behavior of asphalt mixtures.Moreover,it was found that the cohesion and the IDT strength have a good relation in which the minimum condition of the slope,must be met.However,it was observed thatβvalues change depending on material type and temperature.Hence,there is a need to evaluate theseβvalues for varying material and testing temperature.In addition,it was found that the TSR and CR results are highly correlated with an average difference of 1.5%.Furthermore,other tests such as Marshall stability and dynamic immersion were also conducted.It was found that Marshall stability ratio(MSR)and Marshall stability to flow ratio(MSFR)values are less sensitive to moisture effect when measuring moisture resistance compared to TSR values.Finally,the 48 h testing result of the dynamic immersion test showed better correlation with TSR values.