Background/aim: A third of elderly people fall each year. Poor vision is associated with increased risk of falls. The authors aimed to determine if first eye cataract surgery reduces the risk of falling, and to measure associated health gain. Methods: 306 women aged over 70, with cataract, were randomised to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow up every 3 months. Health status was measured after 6 months. Results: Visual function improved in the operated group (corrected binocular acuity improved by 0.25 logMAR units; 8% had acuity worse than 6/12 compared with 37% of controls). Over 12 months of follow up, 76 (49%) operated participants fell at least once, and 28 (18%) fell more than once. 69 (45%) unoperated participants fell at least once, 38 (25%) fell more than once. Rate of falling was reduced by 34% in the operated group (rate ratio 0.66, 95% confidence interval 0.45 to 0.96, p = 0.03). Activity, anxiety, depression, confidence, visual disability, and handicap all improved in the operated group compared with the control group. Four participants in the operated group had fractures (3%), compared with 12 (8%) in the control group (p = 0.04). Conclusion: First eye cataract surgery reduces the rate of falling, and risk of fractures and improves visual function and general health status.
second eye cataract surgery improves visual disability and general health status. The effect on rate of falling remains uncertain.
Dxr)u Lane, London WC2B 5RL; 3Department of Ocular Oncology, Moorfield's Eye Hospital, City Road, London ECJ V 2PD, UK.Summry Both cutaneous and uveal melanoma undergo haematogenous dissemination. Detection of tyrosinase mRNA by reverse transcription-polymerase chain reaction (RT-PCR) has been described as an extremely sensitive way of detecting circulating viable melanoma cells in the penrpheral venous blood, and this technique may be of value in the early detection of dissemination. Also, it has been suggested that surgical manipulation of the eye, such as occurs during enucleation, can provoke uveal melanoma dissemination. The purpose of this study was to evaluate whether tyrosinase mRNA is detectable in the peripheral blood of patients with uveal and cutaneous melanoma and in patients with uveal melanoma undergoing surgical procedures on the eye harbouring the tumour. Venous blood samples from 36 patients diagnosed as having active uveal melanoma and from six patients with advanced metastatic cutaneous melanoma were analysed. In addition, blood samples were spiked with known numbers of cells from three cell lines and four primary uveal melanoma cultures. The reported sensitivity of the technique was confirmed, with an ability to detect down to one cell per ml of blood. All 51 blood samples from the 36 patients with uveal melanoma were negative, and this included 20 perioperative blood samples. The test was also negative for the six patients with advanced cutaneous melanoma. There were two positives among 31 control samples analysed. This study demonstrates that there are far fewer circulating viable melanocytes than has been previously supposed in patients with melanoma and that the RT-PCR is of no clinical value in detecting metastatic melanoma disease. There was no evidence for surgery causing a bolus of melanoma cells to enter the peripheral circulation.Keywords melanoma; metastasis; polymerase chain reaction; tyrosinase; uvea There have been many attempts to detect circulating cells from solid malignant tumours in peripheral blood. Many malignant tumours spread via the bloodstream and, while the number of such cells thought to be present is relatively small, it is these cells that will be a major factor in determining the patients' final outcome. The detection of such cells is potentially important, both clinically, as presumably their presence would be an adverse prognostic factor, and scientifically, as it would allow the isolation, and subsequent study, of such cells by fractionation procedures.Early attempts used microscopy to examine the cells retained on 'sieves' after filtration of blood samples (Goldblatt and Nadel, 1965;McGrew, 1965;Seal, 1964;Stanford, 1971 (McLean et al., 1977(McLean et al., , 1982Shammas and Blodi, 1977) despite the fact that only 1% of patients show evidence of metastases at presentation (Char, 1978). Fraunfelder et al. (1977) suggested that surgery could provoke metastatic spread, and this was followed by the proposal that two-thirds of metastatic disease is attributable t...
Despite the existence of a large number of clustering algorithms, clustering remains a challenging problem. As large datasets become increasingly common in a number of different domains, it is often the case that clustering algorithms must be applied to heterogeneous sets of variables, creating an acute need for robust and scalable clustering methods for mixed continuous and categorical scale data. We show that current clustering methods for mixed-type data are generally unable to equitably balance the contribution of continuous and categorical variables without strong parametric assumptions. We develop KAMILA (KAymeans for MIxed LArge data), a clustering method that addresses this fundamental problem directly. We study theoretical aspects of our method and demonstrate its effectiveness in a series of Monte Carlo simulation studies and a set of real-world applications.
Acuity, stereopsis, and contrast sensitivity each contributed to quality of life, across a range of measures, in elderly women with cataract. Acuity was marginally the most consistently and generally the most strongly associated, but in some analyses stereopsis was more important. Change in quality of life was associated with change in stereopsis and contrast sensitivity.
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