Objective: The aim of this study was to validate a novel pictorial-based Longshi Scale for evaluating a patient’s disability by healthcare professionals and non-professionals. Design: Prospective study. Setting: Rehabilitation departments from a grade A, class 3 public hospital, a grade B, class 2 public hospital, and a private hospital and seven community rehabilitation centers. Subjects: A total of 618 patients and 251 patients with functional disabilities were recruited in a two-phase study, respectively. Main measures: Outcome measure: pictorial scale of activities of daily living (ADLs, Longshi Scale). Reference measure: Barthel Index. The Spearman correlation coefficient was used to analyze the validity of Longshi Scale against Barthel Index. Results: In phase 1 study, from March 2016 to August 2016, the results demonstrated that the Longshi Scale was both reliable and valid (intraclass correlation coefficient based on two-way random effect (ICC2,1) = 0.877–0.974 for intra-rater reliability; ICC2,1 = 0.928–0.979; κ = 0.679–1.000 for inter-rater reliability; intraclass correlation coefficient based on one-way random effect (ICC1,1) = 0.921–0.984 for test–retest reliability and Spearman correlation coefficient = 0.836–0.899). In the second phase, in March 2018, results further demonstrated that the Longshi Scale had good inter-rater and intra-rater reliability among healthcare professionals and non-professionals including therapists, interns, and personal care aids (ICC1,1 = 0.822–0.882 on Day 1; ICC1,1 = 0.842–0.899 on Day 7 for inter-rater reliability). In addition, the Longshi Scale decreased assessment time significantly, compared with the Barthel Index assessment ( P < 0.01). Conclusion: The Longshi Scale could potentially provide an efficient way for healthcare professionals and non-professionals who may have minimal training to assess the ADLs of functionally disabled patients.
Citation: Li H, Wang Y, Dou R, et al. Intraocular pressure changes and relationship with corneal biomechanics after SMILE and FS-LASIK. Invest Ophthalmol Vis Sci. 2016;57:4180-4186. DOI:10.1167/iovs.16-19615 PURPOSE. The purpose of this article was to evaluate intraocular pressure (IOP) changes and investigate the relationship with corneal biomechanics after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS.A total of 193 eyes of 193 patients who underwent SMILE and FS-LASIK procedures were included in this retrospective study. Data were collected preoperatively and postoperatively, including Goldmann-correlated IOP (IOPg), corneal-compensated IOP (IOPcc), corneal hysteresis (CH), and corneal resistance factor (CRF) by ocular response analyzer, noncontact intraocular pressure (IOP NCT ) by noncontact tonometer, and Ehlers, Shah, Dresden, Kohlhaas, Orssengo/Pye by the Pentacam corrected system. Changes in both groups and differences between groups were evaluated. Multiple linear regression models were constructed to explore factors influencing IOP changes.RESULTS. In SMILE, the IOPg, IOPcc, IOP NCT , and Kohlhaas decreased significantly at 1 month postoperatively (P < 0.01), whereas with the Ehlers formula they significantly increased (P < 0.01). IOPs decreased at 3 and 6 months compared with all preoperative values except Ehlers values (P < 0.01), but there was no significant difference between 3 and 6 months (P > 0.05). In FS-LASIK, the IOPg, IOPcc, and IOP NCT decreased significantly at 1 month (P < 0.01), whereas in the Ehlers and Shah formulas they significantly increased (P < 0.01). Compared with preoperative values, the IOPs decreased at 3 and 6 months except in the Ehlers and Shah formulas (P < 0.01). Only IOPg and IOPcc differed between 3 and 6 months (P < 0.05). The Ehlers and Shah formulas were closer to the preoperative IOP for both groups, with variation approximately 1 mm Hg at 6 months postoperatively. Preoperative IOP, postoperative corneal resistance factor, corneal hysteresis, and flat keratometry were enrolled into the regression equations.CONCLUSIONS. IOP underestimation after SMILE or FS-LASIK was related to corneal biomechanics as well as preoperative IOP and flat keratometry. IOP after SMILE seem to remain more stable. Accordingly, the Ehlers and Shah formulas were closer to the preoperative IOP. It may be useful to estimate future IOP with the best-fit models after surgery.
We sought to investigate the relationship between blood-brain barrier (BBB) permeability and microstructural white matter integrity, and their potential impact on long-term functional outcomes in patients with acute ischemic stroke (AIS). We studied 184 AIS subjects with perfusion-weighted MRI (PWI) performed <9 h from last known well time. White matter hyperintensity (WMH), acute infarct, and PWI-derived mean transit time lesion volumes were calculated. Mean BBB leakage rates (K2 coefficient) and mean diffusivity values were measured in contralesional normal-appearing white matter (NAWM). Plasma matrix metalloproteinase-2 (MMP-2) levels were studied at baseline and 48 h. Admission stroke severity was evaluated using the NIH Stroke Scale (NIHSS). Modified Rankin Scale (mRS) was obtained at 90-days post-stroke. We found that higher mean K2 and diffusivity values correlated with age, elevated baseline MMP-2 levels, greater NIHSS and worse 90-day mRS (all p < 0.05). In multivariable analysis, WMH volume was associated with mean K2 ( p = 0.0007) and diffusivity ( p = 0.006) values in contralesional NAWM. In summary, WMH severity measured on brain MRI of AIS patients is associated with metrics of increased BBB permeability and abnormal white matter microstructural integrity. In future studies, these MRI markers of diffuse cerebral microvascular dysfunction may improve prediction of cerebral tissue infarction and functional post-stroke outcomes.
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