Correction of Astigmatism by a Single-Focus Toric Intraocular Lens during Cataract Surgery: Refractive State and Visual Acuity

Purpose: the main purpose of study is to obtain a better visual outcome after implantation of a monofocal toric IOLs by accurate measurement, calculations and visual assessment.Methods. Fifty eyes with astigmatism of more than 2.5 D were included in a hospital-based prospective study. A biometric evaluation is done by Lenstar. Barette's toric calculation method is used to measure toric IOLs power. In a vertical position, preoperative axis marking was done by both bubble marker and direct slit beam. On table, in a horizontal position, axis marking was reassessed. After phacoemulsification, a monofocal Supra Phob toric IOL was implanted and rotated to match corneal axis marking. Best-corrected visual acuity was measured postoperatively at 1 and 3 months.Results. Reduction of mean of refractive astigmatism was reported postoperatively from 4.0 ± 0.79 preoperatively to 0.7 ± 0.28 at 1 month and 0.6 ± 0.27 at 3 months postoperatively. In whole, 96 % has residual astigmatism less than 1 D at 3 months postoperatively, while 8 % eyes had residual astigmatism more than 1 D. In whole, 76 % patients had IOLs rotation of less than or equal to 5°, 20 % patients had it between 6° and 10° and 4 % eyes had more than 10° at day 7 postoperatively, in which repositioning of IOLs was required.Conclusion. To reduce postoperative residual astigmatism after toric IOLs and to get better results, accurate measurement of parameters and proper calculation are essential.

Multiparametric MRI Radiomics for the Early Prediction of Response to Chemoradiotherapy in Patients With Postoperative Residual Gliomas: An Initial Study

PurposeTo evaluate whether multiparametric magnetic resonance imaging (MRI)-based logistic regression models can facilitate the early prediction of chemoradiotherapy response in patients with residual brain gliomas after surgery.Patients and MethodsA total of 84 patients with residual gliomas after surgery from January 2015 to September 2020 who were treated with chemoradiotherapy were retrospectively enrolled and classified as treatment-sensitive or treatment-insensitive. These patients were divided into a training group (from institution 1, 57 patients) and a validation group (from institutions 2 and 3, 27 patients). All preoperative and postoperative MR images were obtained, including T1-weighted (T1-w), T2-weighted (T2-w), and contrast-enhanced T1-weighted (CET1-w) images. A total of 851 radiomics features were extracted from every imaging series. Feature selection was performed with univariate analysis or in combination with multivariate analysis. Then, four multivariable logistic regression models derived from T1-w, T2-w, CET1-w and Joint series (T1+T2+CET1-w) were constructed to predict the response of postoperative residual gliomas to chemoradiotherapy (sensitive or insensitive). These models were validated in the validation group. Calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were applied to compare the predictive performances of these models.ResultsFour models were created and showed the following areas under the ROC curves (AUCs) in the training and validation groups: Model-Joint series (AUC, 0.923 and 0.852), Model-T1 (AUC, 0.835 and 0.809), Model-T2 (AUC, 0.784 and 0.605), and Model-CET1 (AUC, 0.805 and 0.537). These results indicated that the Model-Joint series had the best performance in the validation group, followed by Model-T1, Model-T2 and finally Model-CET1. The calibration curves indicated good agreement between the Model-Joint series predictions and actual probabilities. Additionally, the DCA curves demonstrated that the Model-Joint series was clinically useful.ConclusionMultiparametric MRI-based radiomics models can potentially predict tumor response after chemoradiotherapy in patients with postoperative residual gliomas, which may aid clinical decision making, especially to help patients initially predicted to be treatment-insensitive avoid the toxicity of chemoradiotherapy.

Improving effect of microendoscopic decompression surgery on low back pain in patients with lumbar spinal stenosis and predictive factors of postoperative residual low back pain: a single-center retrospective study

Background Although there are reports on the effectiveness of microendoscopic laminotomy using a spinal endoscope as decompression surgery for lumbar spinal stenosis, predicting the improvement of low back pain (LBP) still poses a challenge, and no clear index has been established. This study aimed to investigate whether microendoscopic laminotomy for lumbar spinal stenosis improves low back pain and determine the preoperative predictors of residual LBP. Methods In this single-center retrospective study, we examined 202 consecutive patients who underwent microendoscopic laminotomy for lumbar spinal stenosis with a preoperative visual analog scale (VAS) score for LBP of ≥40 mm. The lumbar spine Japanese Orthopaedic Association (JOA), and VAS scores for LBP, leg pain (LP), and leg numbness (LN) were examined before and at 1 year after surgery. Patients with a 1-year postoperative LBP-VAS of ≥25 mm composed the residual LBP group. The preoperative predictive factors associated with postoperative residual LBP were analyzed. Results JOA scores improved from 14.1 preoperatively to 20.2 postoperatively (p < 0.001), LBP-VAS improved from 66.7 to 29.7 mm (p < 0.001), LP-VAS improved from 63.8 to 31.2 mm (p < 0.001), and LN-VAS improved from 63.3 to 34.2 mm (p < 0.001). Ninety-eight patients (48.5%) had a postoperative LBP-VAS of ≥25 mm. Multiple logistic regression analysis revealed that Modic type 1 change (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.68–18.68; p = 0.005), preoperative VAS for LBP ≥ 70 mm (OR, 2.19; 95% CI, 1.17–4.08; p = 0.014), and female sex (OR, 1.98; 95% CI, 1.09–3.89; p = 0.047) were preoperative predictors of residual LBP. Conclusion Microendoscopic decompression surgery had an ameliorating effect on LBP in lumbar spinal stenosis. Modic type 1 change, preoperative VAS for LBP, and female sex were predictors of postoperative residual LBP, which may be a useful index for surgical procedure selection.

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Background It’s necessary to analyze the related risk factors and complications of low cardiac output syndrome (LCOS) after operation in children with congenital heart disease (CHD), to elucidate the management strategy of LCOS. Methods CHD children admitted to the department of cardiology in our hospital from January 15, 2019 to October 31, 2020 were included. The personal and clinical data of CHD children with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. Besides, the complication and mortality of LCOS and no LCOS patients were compared. Results A total of 283 CHD patients were included, the incidence of postoperative LCOS in CHD patients was 12.37%. There were significant differences in the age, preoperative oxygen saturation, two-way ventricular shunt, duration of CPB and postoperative residual shunt between two groups (all p < 0.05). Logistic regression analyses indicated that age ≤ 4y(OR2.426, 95%CI1.044 ~ 4.149), preoperative oxygen saturation ≤ 93%(OR2.175, 95%CI1.182 ~ 5.033), two-way ventricular shunt (OR3.994, 95%CI1.247 ~ 6.797), duration of CPB ≥ 60 min(OR2.172, 95%CI1.002 ~ 4.309), postoperative residual shunt (OR1.487, 95%CI1.093 ~ 2.383) were the independent risk factors of LCOS in patients with CHD (all p < 0.05). There were significant differences in the acute liver injury, acute kidney injury, pulmonary infection, tracheotomy, duration of mechanical ventilation, length of ICU stay and mortality (all p < 0.05), no significant difference in the 24 h drainage was found(p = 0.095). Conclusion LCOS after CHD is common, more attentions should be paid to those patients with age ≤ 4y, preoperative oxygen saturation ≤ 93%, two-way ventricular shunt, duration of CPB ≥ 60 min, postoperative residual shunt to improve the prognosis of CHD patients.