BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness c...BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness compared to routine training remains debated.This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance,muscle strength,and pulmonary function in post-stroke patients.AIM To systematically assess the efficacy of RMT in improving exercise tolerance,respiratory muscle strength,and pulmonary function in patients recovering from a stroke,and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a comprehensive search across PubMed,Embase,Web of Science,and the Cochrane Library was conducted on October 19,2023,without temporal restrictions.Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT,control groups,and outcome measures[including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximal voluntary ventilation(MVV),peak expiratory flow(PEF),maximal inspiratory pressure(MIP),maximal expiratory pressure(MEP),and 6-min walking test(6MWT)].Only randomized controlled trials(RCTs)were included.Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool.Statistical analyses,including those using the fixed-effect and random-effects models,sensitivity analysis,and publication bias assessment,were performed using Review Manager software.RESULTS A total of 15 RCTs were included.Results indicated significant improvements in MIP(12.51 cmH2O increase),MEP(6.24 cmH2O increase),and various pulmonary function parameters(including FEV1,FVC,MVV,and PEF).A substantial increase in 6MWT distance(22.26 meters)was also noted.However,the heterogeneity among studies was variable,and no significant publication bias was detected.CONCLUSION RMT significantly enhances walking ability,respiratory muscle strength(MIP and MEP),and key pulmonary function parameters(FEV1,FVC,MVV,and PEF)in post-stroke patients.These findings support the incorporation of RMT into post-stroke rehabilitative protocols.展开更多
The Background: Williams syndrome is a neurodevelopmental multisystem genetic disorder characterized by dysmorphic features and a wide range of congenital cardiac, renal, musculoskeletal anomalies. Presence of cleft p...The Background: Williams syndrome is a neurodevelopmental multisystem genetic disorder characterized by dysmorphic features and a wide range of congenital cardiac, renal, musculoskeletal anomalies. Presence of cleft palate in these patients is an unusual condition. More than 22 cases of sudden cardiac death reported in literature especially during anesthetic management in the patients of Williams syndrome. So these patients present major perioperative challenges to anesthesiologist. The authors report successful anesthetic care for repair of cleft palate in presence of uncorrected patent ductus arteriosus (PDA) and mild supraventricular aortic stenosis (SVAS) in a 3.5-year-old female child diagnosed with Williams syndrome. Case report: Diagnosed case of Williams syndrome with characteristic facial dysmorphic features, SVAS and rare malformation of PDA, was scheduled for cleft palate repair. After keen preoperative assessment, general anesthesia was administered for the procedure with continuous monitoring for vital parameters. Because of dysmorphic features, difficulty was faced during intubation. Otherwise intraoperative procedure was uneventful. Postoperative analgesia was managed with intravenous paracetamol. Conclusion: Being a multisystem disorder, each patient of WS requires meticulous preoperative evaluation and high level of intraoperative and postoperative continuous monitoring regardless of any surgical procedure. Surgical correction of cleft palate in such patients demands very high anesthetic and surgical skills as both share common airway. Present case report highlights the significance of aggressive perioperative management in WS which can result in successful outcome.展开更多
【正】Dear Editor,We thank Dr.Karabas and his colleagues for their interest in our article regarding Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors[1],and we are grateful fo...【正】Dear Editor,We thank Dr.Karabas and his colleagues for their interest in our article regarding Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors[1],and we are grateful for their thoughtful remarks.In展开更多
Background:Pathogenic mechanisms leading to open-angle glaucoma(OAG)are genetically complex.They involve neuroinflammation,elevation of intra-ocular pressures(IOP)and optic nerve hypersensitivity to cellular stresses....Background:Pathogenic mechanisms leading to open-angle glaucoma(OAG)are genetically complex.They involve neuroinflammation,elevation of intra-ocular pressures(IOP)and optic nerve hypersensitivity to cellular stresses.We mapped a locus at chromosome 20q13 that contains a modifier gene for glaucoma severity.While searching for its identity,we named this gene modifier of glaucoma 1(MOG1).The goal of this study is to characterize the mechanism by which MOG1 delays the age of onset of glaucoma when OAG is caused by mutations in the MYOC gene.We hypothesized that MOG1 mechanism may be linked to a specific endophenotype and thus dissected ocular phenotypes present in a large French-Canadian MYOC glaucoma pedigree.Methods:We studied 375 members of the CA pedigree in which autosomal dominant OAG is caused by the MYOCK423E mutation.In this family,wild-type MOG1(normal form)delays the age-at-onset(AAO)of glaucoma.Ocular records of MYOCK423E carriers were reviewed to extract the values of four quantitative traits portraying four endophenotypes:(I)age of maximal intra-ocular pressure(IOP max),(II)IOP progression,(III)rate of optic nerve degeneration and,(IV)AAO defined as the age at which IOP≥22 mmHg or age at which optic disk degeneration was first detected.Endophenotypes were tested for their heritability.A three-stage algorithm was designed to detect double mutants who carry the MYOCK423E mutation and putative MOG1 mutations.Quantitative traits values of double-mutants were then compared.Results:We found 156 individuals who were heterozygotes(HTZ)for MYOCK423E.One hundred and twenty of these were classified affected as they were OAG or had treatment for ocular hypertension(OHT)with IOP≥22 mmHg.The other 36 HTZ were asymptomatic.Only two endophenotypes,AAO and IOP max,showed significant heritability.OHT was the 1st symptom detected in 99%of the affecteds;it always preceded optic nerve damage.AAO of the affecteds ranged from 7 to 63 years old while rates of optic nerve degeneration did not significantly change between them.When comparing the AAOs of the double mutants(those who are MYOCK423E HTZ+MOG1 mutant)with the median AAOs of their respective neighbors(≤1st cousins)who are MYOCK423E HTZ and MOG1 wild-type(called single mutant as they carry a normal MOG1),we observed that the ages-at-onset of OHT in the double mutants were on average 8 years younger than the median of AAOs in their respective single mutant neighbors.Conclusions:These findings demonstrate that age-at-onset(AAO)is a reliable endophenotype to use for discovering the effect of putative MOG1 mutations in MYOCK423E carriers.They also show that the wild-type form of MOG1 delays the AAO of myocilin-induced glaucoma by about 8 years.Our study further suggests that wild-type MOG1 acts on intra-ocular pressures(IOP)by counteracting ocular hypertension(OHT)caused by mutant myocilin proteins before the beginning of optic nerve degeneration.展开更多
Background:To assess minimum and maximum changes in anterior chamber dimensions following routine cataract surgery in non-glaucomatous eyes.Methods:Forty-two eyes(42 participants)underwent routine cataract surgery wit...Background:To assess minimum and maximum changes in anterior chamber dimensions following routine cataract surgery in non-glaucomatous eyes.Methods:Forty-two eyes(42 participants)underwent routine cataract surgery with same surgeon and were assessed preoperatively,1,3,6 and 12 months postoperatively.Primary outcome measure:Angle-to-angle diameter(AAD)(at 0-180°,45-225°,90-270°,135-315°),Anterior-chamber-angle(ACA)(at 0°,45°,90°,135°,180°,225°,270° and 315°)and central anterior chamber depth(ACD)at all visits.Secondary outcome measures:relationship to axial length(AL).Results:The mean AAD and ACA increased post-operatively in all meridians at all visits postoperatively.At 12 months,there was a maximum change in AAD in horizontal meridian(506.55±468.71μm)and least in vertical meridian(256.31±1082.3μm).The mean percentage increase in ACA postoperatively was least at 90o(5%increase compared to 29–35%elsewhere).Central ACD deepened at all postoperative visits and this did not change over 12 months.There was no correlation between AAD,ACA and ACD with AL at any visit.Conclusion:The AAD,ACA and ACD increases following cataract surgery in non-glaucomatous eyes,but at 12 months increase in AAD is least in vertical compared to horizontal meridian.Also,ACA was narrower(only 5%increase)superiorly compared to elsewhere(29–35%increase in ACA).This may have implications with regards to surgeries performed in the anterior chamber and corneal endothelial cell loss.展开更多
Object: To show that increased and invigorated movement of qi and bloodwithin the organism and their concentration in the diseased organ is crucial for acupuncture andlimitations for acupuncture based upon Western med...Object: To show that increased and invigorated movement of qi and bloodwithin the organism and their concentration in the diseased organ is crucial for acupuncture andlimitations for acupuncture based upon Western medicine are not necessarily adequate. Methods:Symptom-related and chronoacupuncture were used within a five stages acupuncture beginning withneedling of competent pair of confluent points and followed by Zi Wu Liu Zhu chronoacupuncture.Results: After 58 symptom-related acupuncture treatments the vision increased from 10 to 70 percentand remained stable. 18 months later one Zi Wu Liu Zhu chronoacupuncture was carried out following aneedling concept of five stages. Within one hour the vision increased from 70 to 90 percent.Conclusions: Ophthalmologists should offer acupuncture to patients suffering from eye in-flammationsand retina scars. Acupuncturists should use Zi Wu Liu Zhu and powerful acupoints and acupointcombinations in order to invigorate and to move qi and blood strongly. This case shows theeffectiveness of acupuncture and chronoacupuncture in a case of retina scar caused by toxoplasmosis.Therefore, acupuncture treatment might be successfully applied in diseases where Western medicinecannot offer help.展开更多
Ulcerative colitis and Crohn’s disease(CD)are characterized by inflammation of the intestinal mucosa and symptoms of abdominal pain and diarrhea.Many studies have shown an association between elevated levels of prost...Ulcerative colitis and Crohn’s disease(CD)are characterized by inflammation of the intestinal mucosa and symptoms of abdominal pain and diarrhea.Many studies have shown an association between elevated levels of prostaglandins and mucosal damage in inflammatory bowel disease.We report a 50-year-old woman with a history of CD and open-angle glaucoma.Her glaucoma was treated with latanoprost,a prostaglandin analog,which was associated with an exacerbation of her CD.On discontinuation of latanoprost,her CD symptoms disappeared completely.This case suggests that in a patient with CD,topical administration of latanoprost may result in sufficient systemic absorption and circulation to promote a relapse of CD.This finding has important implications,not only for patients with inflammatory bowel disease and glaucoma,but also for both ophthalmologists and gastroenterologists.展开更多
Background:Amblyopia(lazy eye)is one of the most common causes of monocular visual impairment.Intensive investigation has shown that amblyopes suffer from a range of deficits not only in the primary visual cortex but ...Background:Amblyopia(lazy eye)is one of the most common causes of monocular visual impairment.Intensive investigation has shown that amblyopes suffer from a range of deficits not only in the primary visual cortex but also the extra-striate visual cortex.However,amblyopic brain processing deficits in large-scale information networks especially in the visual network remain unclear.Methods:Through resting state functional magnetic resonance imaging(rs-fMRI),we studied the functional connectivity and efficiency of the brain visual processing networks in 18 anisometropic amblyopic patients and 18 healthy controls(HCs).Results:We found a loss of functional correlation within the higher visual network(HVN)and the visuospatial network(VSN)in amblyopes.Additionally,compared with HCs,amblyopic patients exhibited disruptions in local efficiency in the V3v(third visual cortex,ventral part)and V4(fourth visual cortex)of the HVN,as well as in the PFt,hIP3(human intraparietal area 3),and BA7p(Brodmann area 7 posterior)of the VSN.No significant alterations were found in the primary visual network(PVN).Conclusion:Our results indicate that amblyopia results in an intrinsic decrease of both network functional correlations and local efficiencies in the extra-striate visual networks.展开更多
基金Scientific Research Project of Hebei Administration of Traditional Chinese Medicine,No.2022307.
文摘BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness compared to routine training remains debated.This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance,muscle strength,and pulmonary function in post-stroke patients.AIM To systematically assess the efficacy of RMT in improving exercise tolerance,respiratory muscle strength,and pulmonary function in patients recovering from a stroke,and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a comprehensive search across PubMed,Embase,Web of Science,and the Cochrane Library was conducted on October 19,2023,without temporal restrictions.Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT,control groups,and outcome measures[including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximal voluntary ventilation(MVV),peak expiratory flow(PEF),maximal inspiratory pressure(MIP),maximal expiratory pressure(MEP),and 6-min walking test(6MWT)].Only randomized controlled trials(RCTs)were included.Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool.Statistical analyses,including those using the fixed-effect and random-effects models,sensitivity analysis,and publication bias assessment,were performed using Review Manager software.RESULTS A total of 15 RCTs were included.Results indicated significant improvements in MIP(12.51 cmH2O increase),MEP(6.24 cmH2O increase),and various pulmonary function parameters(including FEV1,FVC,MVV,and PEF).A substantial increase in 6MWT distance(22.26 meters)was also noted.However,the heterogeneity among studies was variable,and no significant publication bias was detected.CONCLUSION RMT significantly enhances walking ability,respiratory muscle strength(MIP and MEP),and key pulmonary function parameters(FEV1,FVC,MVV,and PEF)in post-stroke patients.These findings support the incorporation of RMT into post-stroke rehabilitative protocols.
文摘The Background: Williams syndrome is a neurodevelopmental multisystem genetic disorder characterized by dysmorphic features and a wide range of congenital cardiac, renal, musculoskeletal anomalies. Presence of cleft palate in these patients is an unusual condition. More than 22 cases of sudden cardiac death reported in literature especially during anesthetic management in the patients of Williams syndrome. So these patients present major perioperative challenges to anesthesiologist. The authors report successful anesthetic care for repair of cleft palate in presence of uncorrected patent ductus arteriosus (PDA) and mild supraventricular aortic stenosis (SVAS) in a 3.5-year-old female child diagnosed with Williams syndrome. Case report: Diagnosed case of Williams syndrome with characteristic facial dysmorphic features, SVAS and rare malformation of PDA, was scheduled for cleft palate repair. After keen preoperative assessment, general anesthesia was administered for the procedure with continuous monitoring for vital parameters. Because of dysmorphic features, difficulty was faced during intubation. Otherwise intraoperative procedure was uneventful. Postoperative analgesia was managed with intravenous paracetamol. Conclusion: Being a multisystem disorder, each patient of WS requires meticulous preoperative evaluation and high level of intraoperative and postoperative continuous monitoring regardless of any surgical procedure. Surgical correction of cleft palate in such patients demands very high anesthetic and surgical skills as both share common airway. Present case report highlights the significance of aggressive perioperative management in WS which can result in successful outcome.
文摘【正】Dear Editor,We thank Dr.Karabas and his colleagues for their interest in our article regarding Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors[1],and we are grateful for their thoughtful remarks.In
文摘Background:Pathogenic mechanisms leading to open-angle glaucoma(OAG)are genetically complex.They involve neuroinflammation,elevation of intra-ocular pressures(IOP)and optic nerve hypersensitivity to cellular stresses.We mapped a locus at chromosome 20q13 that contains a modifier gene for glaucoma severity.While searching for its identity,we named this gene modifier of glaucoma 1(MOG1).The goal of this study is to characterize the mechanism by which MOG1 delays the age of onset of glaucoma when OAG is caused by mutations in the MYOC gene.We hypothesized that MOG1 mechanism may be linked to a specific endophenotype and thus dissected ocular phenotypes present in a large French-Canadian MYOC glaucoma pedigree.Methods:We studied 375 members of the CA pedigree in which autosomal dominant OAG is caused by the MYOCK423E mutation.In this family,wild-type MOG1(normal form)delays the age-at-onset(AAO)of glaucoma.Ocular records of MYOCK423E carriers were reviewed to extract the values of four quantitative traits portraying four endophenotypes:(I)age of maximal intra-ocular pressure(IOP max),(II)IOP progression,(III)rate of optic nerve degeneration and,(IV)AAO defined as the age at which IOP≥22 mmHg or age at which optic disk degeneration was first detected.Endophenotypes were tested for their heritability.A three-stage algorithm was designed to detect double mutants who carry the MYOCK423E mutation and putative MOG1 mutations.Quantitative traits values of double-mutants were then compared.Results:We found 156 individuals who were heterozygotes(HTZ)for MYOCK423E.One hundred and twenty of these were classified affected as they were OAG or had treatment for ocular hypertension(OHT)with IOP≥22 mmHg.The other 36 HTZ were asymptomatic.Only two endophenotypes,AAO and IOP max,showed significant heritability.OHT was the 1st symptom detected in 99%of the affecteds;it always preceded optic nerve damage.AAO of the affecteds ranged from 7 to 63 years old while rates of optic nerve degeneration did not significantly change between them.When comparing the AAOs of the double mutants(those who are MYOCK423E HTZ+MOG1 mutant)with the median AAOs of their respective neighbors(≤1st cousins)who are MYOCK423E HTZ and MOG1 wild-type(called single mutant as they carry a normal MOG1),we observed that the ages-at-onset of OHT in the double mutants were on average 8 years younger than the median of AAOs in their respective single mutant neighbors.Conclusions:These findings demonstrate that age-at-onset(AAO)is a reliable endophenotype to use for discovering the effect of putative MOG1 mutations in MYOCK423E carriers.They also show that the wild-type form of MOG1 delays the AAO of myocilin-induced glaucoma by about 8 years.Our study further suggests that wild-type MOG1 acts on intra-ocular pressures(IOP)by counteracting ocular hypertension(OHT)caused by mutant myocilin proteins before the beginning of optic nerve degeneration.
文摘Background:To assess minimum and maximum changes in anterior chamber dimensions following routine cataract surgery in non-glaucomatous eyes.Methods:Forty-two eyes(42 participants)underwent routine cataract surgery with same surgeon and were assessed preoperatively,1,3,6 and 12 months postoperatively.Primary outcome measure:Angle-to-angle diameter(AAD)(at 0-180°,45-225°,90-270°,135-315°),Anterior-chamber-angle(ACA)(at 0°,45°,90°,135°,180°,225°,270° and 315°)and central anterior chamber depth(ACD)at all visits.Secondary outcome measures:relationship to axial length(AL).Results:The mean AAD and ACA increased post-operatively in all meridians at all visits postoperatively.At 12 months,there was a maximum change in AAD in horizontal meridian(506.55±468.71μm)and least in vertical meridian(256.31±1082.3μm).The mean percentage increase in ACA postoperatively was least at 90o(5%increase compared to 29–35%elsewhere).Central ACD deepened at all postoperative visits and this did not change over 12 months.There was no correlation between AAD,ACA and ACD with AL at any visit.Conclusion:The AAD,ACA and ACD increases following cataract surgery in non-glaucomatous eyes,but at 12 months increase in AAD is least in vertical compared to horizontal meridian.Also,ACA was narrower(only 5%increase)superiorly compared to elsewhere(29–35%increase in ACA).This may have implications with regards to surgeries performed in the anterior chamber and corneal endothelial cell loss.
文摘Object: To show that increased and invigorated movement of qi and bloodwithin the organism and their concentration in the diseased organ is crucial for acupuncture andlimitations for acupuncture based upon Western medicine are not necessarily adequate. Methods:Symptom-related and chronoacupuncture were used within a five stages acupuncture beginning withneedling of competent pair of confluent points and followed by Zi Wu Liu Zhu chronoacupuncture.Results: After 58 symptom-related acupuncture treatments the vision increased from 10 to 70 percentand remained stable. 18 months later one Zi Wu Liu Zhu chronoacupuncture was carried out following aneedling concept of five stages. Within one hour the vision increased from 70 to 90 percent.Conclusions: Ophthalmologists should offer acupuncture to patients suffering from eye in-flammationsand retina scars. Acupuncturists should use Zi Wu Liu Zhu and powerful acupoints and acupointcombinations in order to invigorate and to move qi and blood strongly. This case shows theeffectiveness of acupuncture and chronoacupuncture in a case of retina scar caused by toxoplasmosis.Therefore, acupuncture treatment might be successfully applied in diseases where Western medicinecannot offer help.
基金supported by the 2013–2014 Bristol-Myers Squibb Virology Fellows Research Training Program.The manuscript received no direct financial support.
文摘Ulcerative colitis and Crohn’s disease(CD)are characterized by inflammation of the intestinal mucosa and symptoms of abdominal pain and diarrhea.Many studies have shown an association between elevated levels of prostaglandins and mucosal damage in inflammatory bowel disease.We report a 50-year-old woman with a history of CD and open-angle glaucoma.Her glaucoma was treated with latanoprost,a prostaglandin analog,which was associated with an exacerbation of her CD.On discontinuation of latanoprost,her CD symptoms disappeared completely.This case suggests that in a patient with CD,topical administration of latanoprost may result in sufficient systemic absorption and circulation to promote a relapse of CD.This finding has important implications,not only for patients with inflammatory bowel disease and glaucoma,but also for both ophthalmologists and gastroenterologists.
基金supported by the National Natural Science Foundation of China(grant numbers 81501942,81701665,81500754)by the Fundamental Research Funds for the Central Universities(grant number WK2100230016).
文摘Background:Amblyopia(lazy eye)is one of the most common causes of monocular visual impairment.Intensive investigation has shown that amblyopes suffer from a range of deficits not only in the primary visual cortex but also the extra-striate visual cortex.However,amblyopic brain processing deficits in large-scale information networks especially in the visual network remain unclear.Methods:Through resting state functional magnetic resonance imaging(rs-fMRI),we studied the functional connectivity and efficiency of the brain visual processing networks in 18 anisometropic amblyopic patients and 18 healthy controls(HCs).Results:We found a loss of functional correlation within the higher visual network(HVN)and the visuospatial network(VSN)in amblyopes.Additionally,compared with HCs,amblyopic patients exhibited disruptions in local efficiency in the V3v(third visual cortex,ventral part)and V4(fourth visual cortex)of the HVN,as well as in the PFt,hIP3(human intraparietal area 3),and BA7p(Brodmann area 7 posterior)of the VSN.No significant alterations were found in the primary visual network(PVN).Conclusion:Our results indicate that amblyopia results in an intrinsic decrease of both network functional correlations and local efficiencies in the extra-striate visual networks.
