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The purpose was to compare the ocular higher-order aberrations and the visual performance between photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). Ocular aberrations and visual performance were measured after PRK in 26 eyes, after LASIK in 39 eyes, and in 29 normal myopic control eyes. Ocular aberrations were measured with a Hartmann-Shack aberrometer. Visual performance was evaluated with grating contrast sensitivity, high and low contrast visual acuity, and letter contrast sensitivity under full correction with spectacles. The results were that the root mean square (RMS) values of ocular higher-order aberrations after PRK or LASIK were significantly greater than that of normal controls for both 4-mm and 6-mm zones (PRK; 0.22 ± 0.09 and 0.85 ± 0.24µm, LASIK; 0.20 ± 0.06 and 0.82 ± 0.24µm, normal; 0.10 ± 0.03 and 0.33 ± 0.11µm. P < 0.05 between PRK and normal, LASIK and normal, One Way ANOVA on Ranks). There were no significant differences between PRK and LASIK. The ocular higher-order aberrations increased in proportion with the attempted refractive correction by PRK and LASIK. The ocular higherorder aberrations correlated better with grating contrast sensitivity, low contrast visual acuity, and letter contrast sensitivity than with high contrast visual acuity. There was no difference among normal, PRK and LASIK in all the visual function tests, except between normal and PRK, or between normal and LASIK with letter contrast sensitivity. In conclusion, there was no difference in both ocular higher-order aberrations and visual performance between PRK and LASIK. The result suggests that surgeons can choose refractive procedures according to the corneal conditions or daily activities of patients.

BackgroundQuick contrast sensitivity function (qCSF) method is an advanced quick method for contrast sensitivity function (CSF) evaluation. This study evaluated the contrast sensitivity (CS) of eyes undergoing cataract surgery with multifocal intraocular lens (IOL) implantation and its tolerance to IOL tilt and IOL decentration using the qCSF method.MethodsPatients undergoing uneventful phacoemulsification and a trifocal IOL (Zeiss AT LISA tri 839MP, Carl Zeiss, Germany) or an extended depth-of-focus (EDOF) IOL (Tecnis Symfony ZXR00, Johnson & Johnsons, USA) implantation were included. Monocular contrast sensitivity was measured using the qCSF method at one month post-surgery. IOL tilt and decentration were measured using an optical aberrometer (OPD-Scan III, NIDEK, Japan).ResultsSeventy-two patients/eyes with the 839MP IOL and 64 patients/eyes with the ZXR00 IOL were included. Area under the log CSF (AULCSF) and CS acuity did not differ significantly between the two groups. The ZXR00 IOL group showed better CS at 1 cpd (1.137 ± 0.164 vs. 1.030 ± 0.183 logCS) and 1.5 cpd (1.163 ± 0.163 vs. 1.071 ± 0.161 logCS), while the 839MP IOL group had better CS at 6 cpd (0.855 ± 0.187 vs. 0.735 ± 0.363 logCS). In the 839MP IOL group, all CSF metrics were negatively correlated with IOL tilt (all P < 0.05), while in the ZXR00 IOL group, the CS at 3 cpd had no significant correlation with IOL tilt (P > 0.05). Among myopic eyes, fewer CSF metrics were negatively correlated with IOL tilt in the ZXR00 IOL group than in the 839MP IOL group. No significant correlation was found between CSF metrics and IOL decentration.ConclusionsThe ZXR00 and the 839MP IOL groups presented comparable CSF. CS was negatively correlated with IOL tilt, instead of decentration in multifocal IOLs, particularly among myopic eyes. The ZXR00 IOL had better tolerance to IOL tilt in myopic eyes.

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

To compare changes in ocular higher order aberrations (HOAs) after Visian Implantable Collamer Lens (ICL, STAAR Surgical Co) implantation and wavefront-guided laser epithelial keratomileusis (WFG-LASEK) to correct high myopia. This prospective case series comprised 30 eyes (18 patients) that underwent ICL implantation (ICL group) and 33 eyes (18 patients) that underwent WFG-LASEK (WFG-LASEK group). All eyes had spherical equivalent of -6.00 to -9.00 diopters. Entire ocular, internal optic, and corneal HOAs were measured before surgery and 3 months after surgery using a laser ray tracing aberrometer. Contrast sensitivity testing was performed in 10 eyes from each group at a photopic light level of 85 cd/m(2) and a mesopic level of 3 cd/m(2) 3 months after surgery. In the ICL group, HOAs changed for the entire ocular trefoil-y, spherical aberration, internal optic spherical aberration, and corneal trefoil-y. In the WFG-LASEK group, increased HOAs were observed for total HOAs, entire ocular and corneal spherical aberration, secondary astigmatism, and tetrafoil. The ICL group had lower induced aberration values of entire ocular and corneal HOAs compared with the WFG-LASEK group. No significant differences in contrast sensitivity values between groups at the photopic level were noted; however, contrast sensitivity values were significantly lower for 3 (P=.01) and 6 cycles per degree (P<.001) in the WFG-LASEK group at the mesopic level. At the mesopic level, total HOAs, trefoil-y, spherical aberration, and secondary astigmatism were higher in the WFG-LASEK group. Implantable Collamer Lens implantation induced fewer ocular and corneal HOAs and resulted in better contrast sensitivity at mesopic levels than WFG-LASEK in eyes with high myopia.

Objective To investigate the application value and feasibility of enhanced recovery after surgery (ERAS) in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed. All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia. The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group. Observing indicators included: (1) enteral and parenteral nutritional support treatments; (2) nutrient indexs: levels of serum albumin (Alb) and prealbumin; (3) the recovery of gastrointestinal function: time to anal exsufflation and defecation; (4) postoperative complications and the grading according to Clavien standard; (5) duration of postoperative hospital stay and treatment expenses; (6) risk factors affecting postoperative complications by multivariate analysis; (7) independent risk factors affecting occurrence rate of postoperative complications by univariate analysis. Measurement data with normal distribution were presented as ±s and analyzed using the t test. Non-normal distribution data were analyzed by the Wilcoxon rank sum test. Comparison of repeated data was analyzed by the repeated measures ANOVA. Categorical variables were analyzed using the chi-square test or Fisher's exact probability. The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively. Results (1) During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn't receive oral intake at postoperative day 1, 26 proceeded the intravenous rehydration at postoperative day 4 due to calorie intake less than 80% of calorie requirement, and enteral nutritional support treatment was well-tolerated in the control group. (2) Comparison of nutrient indexs: the levels of serum Alb and prealbumin at postoperative day 1, 3 and 5 were (37.2±3.9)g/L, (39.1±3.5)g/L, (38.5±3.0)g/L and (0.20±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the ERAS group, (37.7±2.8)g/L, (39.0±3.6)g/L, (38.4±3.8)g/L and (0.18±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the control group, respectively, showing no significant difference in the postoperative changing trends between the 2 groups (F=0.357, 0.453, P>0.05). (3) The recovery of gastrointestinal function: time to first anal exsufflation and first defecation were (2.1±0.8)days and (3.4±1.2)days in the ERAS group, (3.2±0.9)days and (5.5±1.5)days in the control group, respectively, showing significant differences between the 2 groups (t=-10.505, -13.174, P 0.05). Eight and 10 patients in the ERAS and control groups underwent gastrointestinal decompression, 6 and 8 patients in the ERAS and control groups underwent retreatment in the intensive care unit (ICU), 3 and 2 patients in the ERAS and control groups were readmitted to the hospital at 3 weeks after discharge, with no significant difference in the above indexes (χ2=0.185, 2.892, P>0.05). (5)The duration of postoperative hospital stay and treatment expenses were (6.8±2.4)days and (25 088±10 336)yuan in the ERAS group, (11.1±3.4)days and (38 819±14 854)yuan in the control group, showing significant differences between the 2 groups (t=-12.782, -9.452, P 10%, tumor staging, tumor differentiation, neoadjuvant chemotherapy and time of food intake were risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the univariate analysis (χ2=2.484, 2.333, 0.061, 8.553, 2.459, 0.163, 3.462, P 10%, tumor staging and neoadjuvant chemotherapy were independent risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the multivariate analysis (OR=0.365, 10.761, 0.290, 8.140, 95% confidence interval : 0.198-0.671, 4.122-28.095, 0.130-0.645, 3.946-16.791, P 0.05). Conclusions ERAS in the esophageal minimally invasive surgery for esophageal cancer is safe and feasible, with the advantages of shorter recovery time of gastrointestinal function and duration of hospital stay, lower treatment expenses and a better application value compared with traditional treatment. Key words: Esophageal neoplasms; Thoracoscopic and laparoscopic esophagectomy; Enhanced recovery after surgery

BackgroundAvahan is a large scale intervention that targets high-risk groups, including female sex workers (FSW), in many epidemiologically heterogeneous districts in southern India. Changes in HIV prevalence post intervention may...

Incidence of Clostridium difficile Infection in Inflammatory Bowel Disease

ObjectiveTo evaluate health-related quality of life (HRQoL) of middle-aged and elderly people with hypertension in Enshi, China, and to explore the important correlates defining HRQoL.MethodsFrom April through July 2018, a self-monitoring intervention program for hypertension control was implemented in a remote area of central China. Participants completed a cross-sectional survey which included demographic characteristics, the Health-related Quality of Life Survey, and the Pittsburgh Sleep Quality Index Survey. Univariate analysis was performed by analysis of variance, and multiple linear regression analysis was used to analyze the influencing factors of HRQoL in middle-aged and elderly hypertensive patients. In the multivariate analysis, the variables with P≤0.05 in the single factor analysis were combined with the professional significance to establish a multiple linear regression model.ResultsInformation from 500 participants was available for analysis. Among them, the scores of PCS and MCS was 31.66 ± 9.50 and 41.38 ± 10.69, respectively. Multivariable regression analyses showed that higher education and sleep quality, and moderate physical activity (30 minutes for at least five days a week) had a positive influence on PCS scores. Higher monthly family income (3,000–5,000 ¥) and sleep quality, regular tea-drinking, having 30 minutes of moderate physical activity at least five days a week were positively associated with MCS scores.ConclusionThe overall HRQoL for rural middle-aged and elderly hypertensive patients in Xuan’en county of Hubei province was poor. Effective relevant measures for the above factors were urgently needed to improve the quality of life for the elderly in rural areas. Awareness of these relevant factors could help health care professionals provide better supportive care.

Prognostic Value of Neutrophil-to-lymphocyte Ratio and Establishment of Novel Preoperative Risk Stratification Model in Bladder Cancer Patients Treated With Radical Cystectomy

Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke

Leptin resistance is discussed to be involved in the genesis of obesity. Therefore, we hypothesized that leptin levels were negatively associated with degree of weight loss in obese children participating in a lifestyle intervention. We studied 248 obese children aged 8-14 years attending the "Obeldicks" lifestyle intervention (mean age 10.6+/-0.2 years, 53% female, 48% pubertal, mean body mass index (BMI) 27.8+/-0.3 kg/m2, and mean standard deviation score [SDS]-BMI 2.43+/-0.03). Baseline leptin concentrations were correlated with change of weight status, waist circumference, and percentage body fat, as calculated from skinfold measurements in the one-year intervention by Pearson correlation and multiple linear regression analyses. Furthermore, the relationship between leptin and cardiovascular risk factors (insulin, insulin resistance index HOMA, blood pressure, lipids, and glucose) were analyzed. A total of 212 children (85%) reduced their overweight, 9 children (4%) dropped out, and 27 children (11%) did not reduce their overweight in the lifestyle intervention "Obeldicks". The mean reduction of SDS-BMI was 0.34+/-0.02. The reduction of SDS-BMI (r=- 0.27), waist circumference (r=- 0.64), and percentage body fat (r=- 0.26) were significantly negatively associated with baseline leptin levels both in univariate analyses and in multiple regression analyses, adjusted to baseline age, BMI, gender and pubertal stage. Baseline leptin concentrations were significantly associated with BMI, pubertal stage, gender, waist circumference, and insulin, but not to any other cardiovascular risk factors in multiple regression analyses. The finding that baseline leptin concentrations were significantly negatively correlated with the degree of weight loss in a lifestyle intervention supports the hypothesis of leptin resistance in obesity. This study is registered at clinicaltrials.gov (NCT00435734).

Although many studies reported improvement of back pain after osteoporosis treatment, there is insufficient evidence to determine whether osteoporosis is painful. We investigated whether bone mineral density correlated with musculoskeletal pain in postmenopausal Korean women aged ≥50 years. Data for postmenopausal women aged ≥50 years were obtained from the fifth Korea National Health and Nutrition Examination Survey database. Demographics, Kellgren-Lawrence grade, and numeric rating scale for pain in the hip and knee joints, presence of back pain, and activity level were analyzed. Only subjects with dual-energy X-ray absorptiometry scans and hip and knee radiographs were included. Those with malignancy, pain medication use, or a history of fragility fractures were excluded. After univariate analysis, multiple linear regression analysis was performed to examine the significant factors correlated with the degree of hip and knee pain. Binary logistic regression analysis was performed to identify factors significantly associated with the presence of back pain. In total, 387 women were included in the data analysis. Age (p = 0.005) was the only significant factor correlated with the intensity of hip pain, while Kellgren-Lawrence grade (p < 0.001) was the only significant factor correlated with knee pain intensity in multiple regression analysis. Binary logistic regression analysis showed that age (p = 0.002) was the only significant factor associated with the presence of back pain. Musculoskeletal pain was not affected by or associated with the bone mineral density (BMD) of the affected body part in postmenopausal Korean women aged ≥50 years after adjusting for the degree of osteoarthritis.

To evaluate the relation between induced changes in ocular higher order aberrations and changes in the contrast sensitivity function in patients undergoing excimer laser photorefractive keratectomy (PRK). Myopic PRK using excimer laser was performed in 31 patients (56 eyes). The preoperative refractive error was -6.2 +/- 2.9 diopters. Before and 1 month after surgery, we measured the ocular higher order aberrations for a 4-mm pupil, and three indices of contrast sensitivity function. From the data collected, the area under the log contrast sensitivity function (AULCSF) was calculated. PRK significantly reduced AULCSF (P = 0.004), low-contrast visual acuity (P = 0.004), and letter-contrast sensitivity (P = 0.013). Coma-like (P < 0.001) and spherical-like (P < 0.001) aberrations were significantly increased by surgery. The change in AULCSF by surgery significantly correlated with the change in coma-like (r = -0.468, P < 0.001) and spherical-like (r = -0.291, P = 0.033) aberrations. The change in low-contrast visual acuity by PRK significantly correlated with the change in coma-like aberration (r = 0.599, P < 0.007), but not with change in spherical-like aberrations (r = 0.136, P = 0.326). There were significant correlations between changes in letter-contrast sensitivity and changes in coma-like (r = -0.450, P < 0.001) and spherical-like (r = -0.255, P = 0.048) aberrations. PRK significantly increases ocular higher order aberrations, which compromise contrast sensitivity function after surgery.

Objective: To investigate the prognostic value of preoperative inflammatory and nutritional condition detection in the postoperative survival, and establish a prognostic model for predicting the survival of patients with gastric cancer. Methods: The clinicopathological data of 1123 patients with gastric cancer who had undergone radical gastrectomy in Tianjin Medical University Cancer Institute & Hospital from January 2005 to December 2014 were retrospectively analyzed. Patients with history of other malignancy, with history of gastrectomy, who had received preoperative treatment, who died during the initial hospital stay or first postoperative month, and missing clinical and pathological information were excluded. Cox univariate and multivariate analyses were used to identify independent clinicopathological factors associated with the survival of these gastric cancer patients. Cox univariate analysis was used to identify preoperative inflammatory and nutritional indexes related to the survival of patients with gastric cancer after radical gastrectomy. Moreover, the Cox proportional regression model for multivariate survival analysis (forward stepwise regression method based on maximum likelihood estimation) was used. The independent clinicopathological factors that affect survival were incorporated into the following three new prognostic models: (1) an inflammatory model: significant preoperative inflammatory indexes identified through clinical and univariate analysis; (2) a nutritional model: significant preoperative nutritional indexes identified through clinical and univariate analysis; and (3) combined inflammatory/nutritional model: significant preoperative inflammatory and nutritional indexes identified through clinical and univariate analysis. A model that comprised only pT and pN stages in tumor TNM staging was used as a control model. The integrated area under the receiver operating characteristic curve (iAUC) and C-index were used to evaluate the discrimination of the model. Model fitting was evaluated by Akaike information criterion analysis. Calibration curves were used to assess agreement between the predicted probabilities and actual probabilities at 3-year or 5-year overall survival (OS). Results: The study cohort comprised 1 123 patients with gastric cancer. The mean age was 58.9±11.6 years, and 783 were males. According to univariate analysis, age, surgical procedure, extent of lymph node dissection, tumor location, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and nerve invasion were associated with 5-year OS after radical gastrectomy for gastric cancer (all P<0.050). Multivariate analysis further identified age (HR: 1.18, 95%CI: 1.03-1.36, P=0.019), maximum tumor size (HR: 1.19, 95%CI: 1.03-1.38, P=0.022), number of examined lymph nodes (HR: 0.79, 95%CI: 0.68-0.92, P=0.003), pT stage (HR: 1.40, 95%CI: 1.26-1.55, P<0.001) and pN stage (HR: 1.28, 95%CI: 1.21-1.35, P<0.001) as independent prognostic factors for OS of gastric cancer patients. Additionally, according to univariate survival analysis, the preoperative inflammatory markers of neutrophil count, percentage of neutrophils, neutrophil/lymphocyte ratio, platelet/neutrophil ratio and preoperative nutritional indicators of serum albumin and body mass index were potential prognostic factors for gastric cancer (all P<0.05). On the basis of the above results, three models for prediction of prognosis were constructed. Variables included in the three models are as follows. (1) Inflammatory model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, and neutrophil-lymphocyte ratio; (2) nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and serum albumin; and (3) combined inflammatory/nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, neutrophil-lymphocyte ratio, and serum albumin. We found that the predictive accuracy of the combined inflammatory/nutritional model, which incorporates both inflammatory indicators and nutrition indicators (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.698),was superior to that of the inflammation model (iAUC: 0.662, 95% CI: 0.673-0.706;C-index: 0.675), nutritional model (iAUC: 0.666, 95% CI: 0.642-0.698, C-index: 0.672), and TNM staging control model (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.658). Furthermore, the combined inflammatory/nutritional model had better fitting performance (AIC: 10 762) than the inflammatory model (AIC: 10 834), nutritional model (AIC: 10 810), and TNM staging control model (AIC: 10 974). Conclusions: Preoperative percentage of neutrophils, NLR, and BMI have predictive value for the prognosis of gastric cancer patients. The inflammatory / nutritional model can be used to predict the survival and prognosis of gastric cancer patients on an individualized basis.

Background/Objectives: The objective was to assess visual performance and the overall satisfaction of extended-depth-of-focus (EDOF) contact lenses (CLs) in a presbyopic population. Methods: We prospectively investigated visual acuity at all distances (0.3, 0.4, 0.5, 0.7, 1, and 5 m), higher-order aberrations (HOAs), contrast sensitivity function, and overall satisfaction score, before and during EDOF CL wear in 42 eyes of 21 presbyopic subjects (1 man and 20 women). Results: Binocular visual acuity at 0.3, 0.5, 0.7, 1, 2, 3, and 5 m when wearing EDOF CLs was 0.01 ± 0.14, −0.08 ± 0.02, −0.08 ± 0.02, −0.08 ± 0.00, −0.08 ± 0.00, −0.08 ± 0.02, and −0.07 ± 0.02, respectively. We found a significant improvement at near to intermediate distances (0.3, and 0.5 m), but no significant change at intermediate to far distances (0.7, 1, 2, 3, and 5 m) between before and during CL wear. The area under the log contrast sensitivity function was not significantly changed under photopic nor mesopic conditions (p = 0.099, and p = 0.689). Ocular third-order aberrations, fourth-order aberrations, or total HOAs for a 4 mm pupil significantly increased. The overall satisfaction score significantly improved by wearing EDOF CLs. Conclusions: EDOF CLs significantly improved visual acuity at near to intermediate distances, while maintaining far vision, and the effect of contrast sensitivity was minimal, suggesting the viability of presbyopic correction in such candidates.