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Scientific Reports Jul 2018Smartphone-based fundus photography (SBFP) allows for a cheap and mobile fundus examination with the potential to revolutionize eye care especially in low income... (Comparative Study)
Comparative Study
Smartphone-based fundus photography (SBFP) allows for a cheap and mobile fundus examination with the potential to revolutionize eye care especially in low income settings. The purpose of this study was to assess the impact of pupil dilation on image quality in optic nerve head (ONH) imaging and vertical cup-to-disc ratio (vCDR) evaluation with SBFP. Eyes with glaucoma or suspected to have glaucoma were imaged with conventional digital fundus photography (CFP) and SBFP undilated and following dilation, all monoscopically. SBFP was possible in 74% of eyes without dilation and in 98% following dilation. Better image quality on SBFP was achieved with dilation and complete visualization of the optic disc rim was possible in 46% of images without dilation and on 94% of images with dilation. VCDR measurements on images obtained following dilation highly correlated with measurements on CFP (coefficient of correlation r = 0.91, p < 0.001), whereas vCDR on images obtained without dilation correlated less well with CFP (r = 0.70, p < 0.001). SBFP for ONH evaluation is promising, however dilation appears mandatory to achieve results comparable to optic disc evaluation on CFP. ONH imaging with smartphones without dilation might bear the risk of underestimating the CDR and hence overlooking patients at risk for glaucoma.
Topics: Adult; Aged; Aged, 80 and over; Diagnostic Techniques, Ophthalmological; Dilatation; Female; Fundus Oculi; Glaucoma; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Optic Disk; Photography; Smartphone
PubMed: 29980724
DOI: 10.1038/s41598-018-28585-6 -
Gastroenterology Jun 2023For patients with achalasia experiencing persistent or recurrent symptoms after laparoscopic Heller myotomy (LHM), pneumatic dilation (PD) is the most frequently used... (Randomized Controlled Trial)
Randomized Controlled Trial
The Efficacy of Peroral Endoscopic Myotomy vs Pneumatic Dilation as Treatment for Patients With Achalasia Suffering From Persistent or Recurrent Symptoms After Laparoscopic Heller Myotomy: A Randomized Clinical Trial.
BACKGROUND & AIMS
For patients with achalasia experiencing persistent or recurrent symptoms after laparoscopic Heller myotomy (LHM), pneumatic dilation (PD) is the most frequently used treatment. Per-oral endoscopic myotomy (POEM) is increasingly being investigated as rescue therapy. This study aimed to determine the efficacy of POEM vs PD for patients with persistent or recurrent symptoms after LHM.
METHODS
This randomized multicenter controlled trial included patients after LHM with an Eckardt score >3 and substantial stasis (≥2 cm) on timed barium esophagogram and randomized to POEM or PD. The primary outcome was treatment success, defined as an Eckardt score of ≤3 and without unscheduled re-treatment. Secondary outcomes included the presence of reflux esophagitis, high-resolution manometry, and timed barium esophagogram findings. Follow-up duration was 1 year after initial treatment.
RESULTS
Ninety patients were included. POEM had a higher success rate (28 of 45 patients [62.2%]) than PD (12 of 45 patients [26.7%]; absolute difference, 35.6%; 95% CI, 16.4%-54.7%; P = .001; odds ratio, 0.22; 95% CI, 0.09-0.54; relative risk for success, 2.33; 95% CI, 1.37-3.99). Reflux esophagitis was not significantly different between POEM (12 of 35 [34.3%]) and PD (6 of 40 [15%]). Basal lower esophageal sphincter pressure and integrated relaxation pressure (IRP-4) were significantly lower in the POEM group (P = .034; P = .002). Barium column height after 2 and 5 minutes was significantly less in patients treated with POEM (P = .005; P = .015).
CONCLUSIONS
Among patients with achalasia experiencing persistent or recurrent symptoms after LHM, POEM resulted in a significantly higher success rate than PD, with a numerically higher incidence of grade A-B reflux esophagitis.
NETHERLANDS TRIAL REGISTRY
NL4361 (NTR4501), https://trialsearch.who.int/Trial2.aspx?TrialID = NTR4501.
Topics: Humans; Esophageal Achalasia; Heller Myotomy; Esophageal Sphincter, Lower; Dilatation; Barium; Treatment Outcome; Esophagitis, Peptic; Natural Orifice Endoscopic Surgery
PubMed: 36907524
DOI: 10.1053/j.gastro.2023.02.048 -
Scientific Reports May 2016Detecting and integrating information across the senses is an advantageous mechanism to efficiently respond to the environment. In this study, a simple auditory-visual...
Detecting and integrating information across the senses is an advantageous mechanism to efficiently respond to the environment. In this study, a simple auditory-visual detection task was employed to test whether pupil dilation, generally associated with successful target detection, could be used as a reliable measure for studying multisensory integration processing in humans. We recorded reaction times and pupil dilation in response to a series of visual and auditory stimuli, which were presented either alone or in combination. The results indicated faster reaction times and larger pupil diameter to the presentation of combined auditory and visual stimuli than the same stimuli when presented in isolation. Moreover, the responses to the multisensory condition exceeded the linear summation of the responses obtained in each unimodal condition. Importantly, faster reaction times corresponded to larger pupil dilation, suggesting that also the latter can be a reliable measure of multisensory processes. This study will serve as a foundation for the investigation of auditory-visual integration in populations where simple reaction times cannot be collected, such as developmental and clinical populations.
Topics: Acoustic Stimulation; Adolescent; Adult; Auditory Perception; Dilatation; Female; Humans; Male; Photic Stimulation; Pupil; Visual Perception; Young Adult
PubMed: 27189316
DOI: 10.1038/srep26188 -
BMJ Open Apr 2019The purpose of this study was to systematically review the outcomes of the use of one-shot dilation (OSD) and serial tract dilation for percutaneous nephrolithotomy... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this study was to systematically review the outcomes of the use of one-shot dilation (OSD) and serial tract dilation for percutaneous nephrolithotomy (PCNL).
METHODS
A systematic review and meta-analysis was conducted. The randomised controlled trials (RCTs) included in the study were identified from EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials. The last search was performed on 30 April 2018. Summary effects were calculated as risk ratios (RRs) with 95% CIs or mean differences (MDs) with 95% CIs. The endpoints included access time, fluoroscopy time, successful dilation rate, stone-free rate, postoperative decrease in haemoglobin levels, transfusion rate, complication rate and length of postoperative hospital stay.
RESULTS
A total of seven RCTs were included in the study, with clinical data reported for 697 patients. The overall access time was approximately 110 s shorter in the OSD group than in the serial dilation group (MD, -110.14; 95% CI -161.99 to -58.30; p<0.0001). The fluoroscopy time was shorter with OSD in all RCTs. In addition, the decrease in postoperative haemoglobin levels was approximately 2.3g/L less in patients in the OSD group than in those in the serial dilation group (MD, -0.23; 95% CI-0.39 to -0.07; p=0.004). No relationship was found between the successful dilation rate, stone-free rate, transfusion rate, or complication rate and the method of tract dilation.
CONCLUSION
OSD is a safe and efficacious tract dilation technique that can reduce the access time, fluoroscopy time and postoperative decrease in haemoglobin level. No difference was found in the successful dilation rate, stone-free rate, transfusion rate or rate of complications between the OSD and serial dilation groups. The difference in the length of postoperative hospital stay was uncertain. OSD may be a better method of tract creation for PCNL.
Topics: Dilatation; Fluoroscopy; Humans; Kidney Calculi; Length of Stay; Nephrolithotomy, Percutaneous; Operative Time; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31005926
DOI: 10.1136/bmjopen-2018-025871 -
Journal of Pediatric Gastroenterology... May 2017Although several studies report on the experience with adult eosinophilic esophagitis (EoE)-related stricture, outcomes for pediatric patients with EoE-associated...
OBJECTIVES
Although several studies report on the experience with adult eosinophilic esophagitis (EoE)-related stricture, outcomes for pediatric patients with EoE-associated fibrostenosis and stricture is more limited. To address this, we aim to identify the adverse event (AE) rate and short-term outcomes of the largest reported cohort of children with EoE to undergo esophageal dilation for management of symptomatic esophageal narrowing.
METHODS
A retrospective assessment of all children, 18 years and younger, who underwent esophageal dilation at an academic children's hospital during a 5-year period was conducted. Clinical, endoscopic, histologic, and outcomes of dilation were extracted from the medical record. AEs were captured within a standardized endoscopic AE database. Grade 2 AEs (requiring unanticipated medical intervention) were termed significant. Dilation-related events were compared between patients with EoE, without EoE, and those undergoing standard upper endoscopy.
RESULTS
Of the 451 total dilations, 68 dilations were performed in 40 EoE patients (mean age 13.8 years, standard deviation 3.3 years [4.6-18.9 years]). Forty-three percent (17/40) had repeat dilation during the study period. Dilation-related grade 2 AE rates in EoE and in non-EoE patients were 2.9% and 3.1%, respectively (P > 0.5). Chest pain (any grade AE) was reported in 14.7% of EoE dilations. No significant associations were found between postprocedural pain and dilation method, final dilator size, medical therapy, or esophageal eosinophilia. No perforations or significant hemorrhage were reported.
CONCLUSIONS
We conclude that dilation can be performed safely in children with EoE. In the appropriate clinical setting, cautious dilation may be considered in the management of fibrostenotic EoE.
Topics: Adolescent; Child; Child, Preschool; Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagoscopy; Female; Follow-Up Studies; Humans; Male; Retrospective Studies; Treatment Outcome
PubMed: 28055990
DOI: 10.1097/MPG.0000000000001336 -
Journal of Pediatric Surgery Mar 2021There are some studies about the effect of postoperative anal dilatation on anastomotic stenosis and Hirschsprung-associated enterocolitis (HAEC), but we have not seen...
BACKGROUND/PURPOSE
There are some studies about the effect of postoperative anal dilatation on anastomotic stenosis and Hirschsprung-associated enterocolitis (HAEC), but we have not seen any report about preoperative anal dilatation. We hypothesized that preoperative anal dilatation could reduce the incidence of HAEC and facilitate the operation. We aim to compare the HAEC rates and postoperative complications between groups who either had or did not have anal dilatations (AD or NAD) prescribed before laparoscopic-assisted Soave pull-through procedures for Hirschsprung disease (HD); by this means, we will evaluate the benefit of dilatations before the surgery for HD.
METHODS
A retrospective review of children with HD operated in our hospital between 2014 and 2018 was performed. Those with 21 trisomy, total colonic aganglionosis, multiple stage procedures, serious congenital malformations, and lost to follow-up were excluded. Patients were divided into preoperative anal dilatation group (AD group) and no preoperative anal dilatation group (NAD group). Routine anal dilatation was performed in both groups from 2 weeks after laparoscopic-assisted Soave pull-through. The anal dilatation was carried out daily with metal anal dilators with size appropriate to the age of the child. The size of the anal dilators was increased by 1 mm every 2 weeks for at least 3 months. Demographic data, operation time, pre- and postoperative HAEC rates and postoperative obstructive symptoms between groups were compared. Significance was considered at P < 0.05.
RESULTS
There were 95 children (17 female and 78 male) included, 36 AD and 59 NAD. There was no significant difference in demographic data between the two groups. The incidence of HAEC between the groups was not different both preoperatively (14% vs. 24%, P = 0.298) and postoperatively (11% vs. 19%, P = 0.171). The postoperative obstructive symptoms rates were 19% versus 22% for the AD and NAD groups, respectively (P = 0.802). The operation time of group AD was significantly shorter than that of group NAD (P = 0.008). Preoperative anal dilatation could shorten the operation time in short and typical-segment (2.08 ± 0.39 vs. 2.67 ± 0.37, P = 0.009 and 3.05 ± 0.38 vs. 3.29 ± 0.46, P = 0.042), but has no significant effect on long-segment disease (3.85 ± 0.41 vs. 3.89 ± 0.30, P = 0.839).
CONCLUSION
We have not shown a reduced risk of developing HAEC or postoperative obstructive symptoms if anal dilatations are prescribed before surgery. However, it may decrease the difficulties of surgeries, so the operative time is shortened.
LEVEL OF EVIDENCE
Prognosis study.
LEVEL
II.
Topics: Anal Canal; Child; Digestive System Surgical Procedures; Dilatation; Enterocolitis; Female; Hirschsprung Disease; Humans; Infant; Male; Postoperative Complications; Retrospective Studies
PubMed: 32534905
DOI: 10.1016/j.jpedsurg.2020.05.008 -
Experimental Brain Research Feb 2021We investigated whether Early Posterior Negativity (EPN) indicated the subjective dilation of time when judging the duration of arousing stimuli. Participants performed...
We investigated whether Early Posterior Negativity (EPN) indicated the subjective dilation of time when judging the duration of arousing stimuli. Participants performed a visual temporal bisection task along with high-level and low-level arousing auditory stimuli, while we simultaneously recorded EEG. In accordance with previous studies, arousing stimuli were temporally overestimated and led to higher EPN amplitude. Yet, we observed that time dilation and EPN amplitude were significantly correlated and this effect cannot be explained by confounds from stimulus valence. We interpret our findings in terms of the pacemaker-accumulator model of human timing, and suggest that EPN indicates an arousal-based increasing of the speed of our mental clock.
Topics: Arousal; Dilatation; Emotions; Humans; Time Perception
PubMed: 33277996
DOI: 10.1007/s00221-020-05991-9 -
Practical Radiation Oncology Nov 2019Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS);... (Review)
Review
PURPOSE
Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS); however, no standard protocol exists. This review seeks to update our current state of knowledge concerning VS and VDT in radiation oncology.
METHODS AND MATERIALS
A comprehensive literature review (1972-2017) was conducted using search terms "vaginal stenosis," "radiation," and "vaginal dilator." Information was organized by key concepts including VS definition, time course, pathophysiology, risk factors, and interventions.
RESULTS
VS is a well-described consequence of pelvic RT, with early manifestations and late changes evolving over several years. Strong risk factors for VS include RT dose and volume of vagina irradiated. Resultant vaginal changes can interfere with sexual function and correlational studies support the use of preventive VDT. The complexity of factors that drive noncompliance with VDT is well recognized. There are no prospective data to guide optimal duration of VDT, and the consistency with which radiation oncologists monitor VS and manage its consequences is unknown.
CONCLUSIONS
This review provides information concerning VS definition, pathophysiology, and risk factors and identifies domains of VDT practice that are understudied. Prospective efforts to monitor and measure outcomes of patients who are prescribed VDT are needed to guide practice.
Topics: Constriction, Pathologic; Dilatation; Female; Humans; Radiation Oncology; Vagina
PubMed: 31302301
DOI: 10.1016/j.prro.2019.07.001 -
Urology Journal Feb 2019Nephrostomy tract creation is a key step to perform a successful percutaneous nephrolithotomy (PCNL). In an attempt to improve the conventional technique of the tract... (Comparative Study)
Comparative Study
PURPOSE
Nephrostomy tract creation is a key step to perform a successful percutaneous nephrolithotomy (PCNL). In an attempt to improve the conventional technique of the tract dilation, a Chinese one-shot dilation was developed and compared with the sequential fascial dilation.
MATERIALS AND METHODS
We retrospectively reviewed medical records of 116 patients who had undergone 116 PCNL in our department from January 2012 to December 2012. The nephrostomy tracts had been created by using Chinese one-shot (one-shot group, 59 cases) or sequential fascial dilation technique (sequential group, 57 cases). Tract creation time, hemorrhage loss, overall renal function, tract dilation failure and major complications were compared between the two groups.
RESULTS
The one-shot group had a significantly shorter mean (SD) tract creation time (1.9±0.4 vs 4.6±0.9 min, P<0.001) and lower mean (SD) decrease in hemoglobin concentration (0.59±0.32 vs 0.68±0.37 g/dL, P=0.0009) compared to the sequential group, respectively. There were no significant differences in mean (SD) value changes of pre- and post-operative serum creatine concentrations (4.6±11.3 vs 4.9±14.7 ?mol/L, P=0.259) between the one-shot and sequential group. No tract dilation failure or major complications occurred in both of the groups.
CONCLUSION
This study demonstrated that the Chinese one-shot dilation technique is as safe and feasible as the conventional sequential fascial dilation. Furthermore, a greater reduction in tract creation time and blood loss was achieved using this technique.
Topics: Adult; Aged; Blood Loss, Surgical; Creatinine; Dilatation; Fascia; Feasibility Studies; Female; Hemoglobins; Humans; Male; Middle Aged; Nephrolithotomy, Percutaneous; Operative Time; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 30798569
DOI: 10.22037/uj.v16i1.4610 -
Medicine Apr 2017Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear.
AIMS
Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE.
METHODS
STUDY SELECTION CRITERIA:: Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis.
DATA COLLECTION AND EXTRACTION
Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies.
STATISTICAL METHOD
Pooled proportions were calculated using fixed- and random-effects model. I statistic was used to assess heterogeneity among studies.
RESULTS
Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I (inconsistency) was 0% (95% confidence interval [CI] = 0-49.8) and Egger: bias was 0.06 (95% CI = -0.30 to 0.42).
CONCLUSIONS
In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting.
Topics: Dilatation; Eosinophilic Esophagitis; Esophagoscopy; Humans; Treatment Outcome
PubMed: 28383396
DOI: 10.1097/MD.0000000000005877