Das Gangbild beim Morbus Parkinson ist gekennzeichnet durch eine deutlich reduzierte Ganggeschwindigkeit, was hauptsächlich durch eine reduzierte Schrittlänge bedingt ist, während die Schrittfrequenz meist leicht erhöht ist. L-Dopa vergrößert die Schrittlänge, während die Schrittfrequenz unbeeinflusst bleibt. Während chronische Stimulation des Thalamus praktisch keinen Einfluss auf den Gang beim Morbus Parkinson hat, verbessert die Stimulation des Nucl. subthalamicus das Gehen klinisch deutlich. Ziel der Studie ist, Veränderungen der Gangparameter zu quantifizieren und mögliche Unterschiede oder Synergien von Nucl. subthalamicus-Stimulation und L-Dopa zu erfassen. Es wurden 8 Patienten mit Morbus Parkinson unter chronischer bilateraler Stimulation des Nucl. subthalamicus und 12 altersentsprechende Kontrollpersonen untersucht. Die Patienten gingen auf einem Laufband mit einem ultraschallgesteuerten Geschwindigkeitsregelungssystem, das kontinuierlich die Geschwindigkeit des Laufbandes und ein in das Gesichtsfeld projiziertes Fließmuster der tatsächlichen Ganggeschwindigkeit anpasst. Gangparameter wurden für mindestens 120 Schrittzyklen für vier Behandlungskombinationen in einem entsprechenden Cross-over-Design untersucht: mit/ohne Stimulation und mit/ohne L-Dopa. Die Nucl. subthalamicus-Stimulation verdreifachte die durchschnittliche Geschwindigkeit von 1,2 km/h auf 3,5 km/h und die Schrittlänge von 34cm auf 99cm, während die Schrittfrequenz mit 118/min praktisch unverändert blieb. Diese Ergebnisse liegen bereits im Bereich der gesunden Kontrollgruppe. L-Dopa alleine hatte einen ähnlichen Effekt. Die Kombination Stimulation und L-Dopa verbesserte die Ganggeschwindigkeit auf 4,3 km/h, die Schrittlänge auf 120cm. Allerdings benötigten nicht alle Patienten zusätzlich zur Stimulation L-Dopa, um diese Werte zu erreichen. Ähnliche Ergebnisse wurden sowohl mit als auch ohne optisches Fließmuster beobachtet. Trainingseffekte waren je nach Reihenfolge der Versuchsdurchführung zu sehen, jedoch wurden diese durch das Cross-over-Design des Versuches berücksichtigt. Auch der visuelle Einfluss, der normalerweise beim Gehen auf dem Laufband fehlt, spielte für die beobachteten Effekte keine Rolle. Die Nucl. subthalamicus-Stimulation beeinflusst ähnlich wie L-Dopa die Ganggeschwindigkeit über eine Zunahme der Schrittlänge ohne Schittfrequenzänderung und damit über Mechanismen, die räumliche Gangparameter betreffen. Die Gangparameter mit Nucl. subthalamicus-Stimulation alleine liegen bereits im Bereich von denen gesunder Kontrollpersonen.
To determine the relative importance and associated risk factors of vision-specific distress and depressive symptoms in people with visual impairments.In this cross-sectional study, 162 adult patients with visual acuity less than 6/12 were interviewed using telephone-administered questionnaires. Vision-specific distress was assessed with the emotional well-being scale of the Impact of Vision Impairment Questionnaire. Depressive symptoms were assessed with the Patient Health Questionnaire-9. Other measures including vision-specific functioning, coping, and social support were also assessed. Multiple regression and commonality analysis were used to determine the relative contribution of factors explaining variance in vision-specific distress and depressive symptoms.Vision-specific distress and depressive symptoms were strongly associated. Vision-specific functioning (βs = 0.47, P < 0.001), avoidant coping (βs = -0.32, P < 0.001), social coping efficacy (βs = -0.17, P = 0.001), and depressive symptoms (βs = 0.18, P = 0.006) were significant determinants of vision-specific distress. Vision-specific functioning accounted for 37.7% of the unique variance in this model. Vision-specific distress was an important risk factor for depression, accounting for 36.6% of the unique variance in depressive symptoms.Vision-specific distress is related to a person's ability to manage the practical and social challenges of vision impairment. Further work is required to distinguish vision-specific distress and depression and to examine what interventions are best to target vision-specific distress.
Abstract With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater. We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated. There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22–80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1–5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis. Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.
Objectives. Alterations in retinal vascular calibre, particularly wider venular calibre, have been independently associated with elevated markers of inflammation and cardiovascular risk in the general population. We hypothesized that retinal vascular calibre would be altered in patients with RA, who are known to have both elevated cardiovascular risk and chronic, systemic inflammation.
Objective The goal discussion blood fills the class,the armor hadrosaurus,the endoxan in treatment,in the heavy paraquat the effect,choice scientific method treatment paraquat poison curing.Methods The method choice clinical,the specific weight paraquat is poisoned 78 human of early times to carry on the blood to fill the class,the armor hadrosaurus,the endoxan treatment review analysis. Results (But finally the specific weight gas casualty 23 human of only 1 person survives quality of life to be bad); The moderate 55people,accept treat 45 people to have 36 people to survive,9 dead,gives up the curer 10 average per person deaths.Conclusions Early time use blood fills the class,the armor hadrosaurus,the endoxan treatment paraquat poison moderate gas casualty survival rate distinct enhancement,gives up the treatment and the specific weight gas casualty mortality rate is extremely high,reaches above 90%.
Volumetric TSE (3D-TSE) techniques are increasingly replacing volumetric magnetization-prepared gradient recalled-echo (3D-GRE) sequences due to improved metastasis detection. In addition to providing a baseline for assessing postcontrast enhancement, precontrast T1WI also identifies intrinsic T1 hyperintensity, for example, reflecting melanin or blood products. The ability of precontrast 3D-TSE to demonstrate intrinsic T1 hyperintensity is not clear from the literature; thus, this study compares precontrast 3D-TSE and 3D-GRE sequences for identifying intrinsic T1 hyperintensity in patients with metastatic melanoma.
Currently, many surgeons place a prophylactic drain in the abdominal or pelvic cavity after colorectal anastomosis as a conventional treatment. However, some trials have demonstrated that this procedure may not be beneficial to the patients. To determine whether prophylactic placement of a drain in colorectal anastomosis can reduce postoperative complications. We systematically searched all the electronic databases for randomized controlled trials (RCTs) that compared routine use of drainage to non-drainage regimes after colorectal anastomosis, using the terms "colorectal" or "colon/colonic" or "rectum/rectal" and "anastomo*" and "drain or drainage." Reference lists of relevant articles, conference proceedings, and ongoing trial databases were also screened. Primary outcome measures were clinical and radiological anastomotic leakage. Secondary outcome measures included mortality, wound infection, re-operation, and respiratory complications. We assessed the eligible studies for risk of bias using the Cochrane Risk of Bias Tool. Two authors independently extracted data. Eleven RCTs were included (1803 patients in total, 939 patients in the drain group and 864 patients in the no drain group). Meta-analysis showed that there was no statistically significant differences between the drain group and the no drain group in (1) overall anastomotic leakage (relative risk (RR) = 1.14, 95 % confidence interval (CI) 0.80–1.62, P = 0.47), (2) clinical anastomotic leakage (RR = 1.39, 95 % CI 0.80–2.39, P = 0.24), (3) radiologic anastomotic leakage (RR = 0.92, 95 % CI 0.56–1.51, P = 0.74), (4) mortality (RR = 0.94, 95 % CI 0.57–1.55, P = 0.81), (5) wound infection (RR = 1.19, 95 % CI 0.84–1.69, P = 0.34), (6) re-operation (RR = 1.18, 95 % CI 0.75–1.85, P = 0.47), and (7) respiratory complications (RR = 0.82, 95 % CI 0.55–1.23, P = 0.34). Routine use of prophylactic drainage in colorectal anastomosis does not benefit in decreasing postoperative complications.
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