Purpose: To examine the benefits and feasibility of a mobile, real-time, community-based, teleophthalmology program for detecting eye diseases in the New York metro area. Design: Single site, nonrandomized, cross-sectional, teleophthalmologic study. Methods: Participants underwent a comprehensive evaluation in a Wi-Fi–equipped teleophthalmology mobile unit. The evaluation consisted of a basic anamnesis with a questionnaire form, brief systemic evaluations and an ophthalmologic evaluation that included visual field, intraocular pressure, pachymetry, anterior segment optical coherence tomography, posterior segment optical coherence tomography, and nonmydriatic fundus photography. The results were evaluated in real-time and follow-up calls were scheduled to complete a secondary questionnaire form. Risk factors were calculated for different types of ophthalmological referrals. Results: A total of 957 participants were screened. Out of 458 (48%) participants that have been referred, 305 (32%) had glaucoma, 136 (14%) had narrow-angle, 124 (13%) had cataract, 29 had (3%) diabetic retinopathy, 9 (1%) had macular degeneration, and 97 (10%) had other eye disease findings. Significant risk factors for ophthalmological referral consisted of older age, history of high blood pressure, diabetes mellitus, Hemoglobin Alc measurement of ≥6.5, and stage 2 hypertension. As for the ocular parameters, all but central corneal thickness were found to be significant, including having an intraocular pressure >21 mm Hg, vertical cup-to-disc ratio ≥0.5, visual field abnormalities, and retinal nerve fiber layer thinning. Conclusions: Mobile, real-time teleophthalmology is both workable and effective in increasing access to care and identifying the most common causes of blindness and their risk factors.
IntroductionAccurate measurement of PO 2 in biologic tissues has been of interest to both researchers and clinicians for many years [1]. For basic scientists measurement of PO 2 provides insight into the complexities of oxygen flux at the tissue level, whereas for clinicians it moves the monitoring window a step closer to the cell. PO 2 monitoring has been exploited most effectively by radiation oncologists, who have used intratumoral PO 2 measurements to plan and guide radiotherapy [2]. Many articles in the anesthesia and critical care literature report the application of different technologies designed to measure tissue PO 2 [1,[3][4][5][6][7][8][9][10][11][12][13][14], but the clinical use of PO 2 measurement has largely been limited to assessment of brain tissue [15,16].Existing technologies for measuring tissue PO 2 are either too expensive for everyday clinical use [14] or are based on polarographic principles [17], meaning that oxygen is consumed in the measurement process. In time this oxygen consumption affects the signal itself, and this effect persists as tissue PO 2 decreases, perhaps making polarographic devices less suitable for detection of tissue hypoxia. We hypothesized that a PO 2 measurement technique based on dynamic fluorescence quenching would provide a way to overcome the limitations of the current polarographic technique. We report here a head-to-head bench comparison of PO 2 measurement using polarography versus measurement using dynamic fluorescence quenching. We also present preliminary data from an animal model of tissue ischemia and hypoxia that provide FiO 2 =fractional inspired oxygen; PO 2 =partial oxygen tension. AbstractIntroduction and methods Dynamic fluorescence quenching is a technique that may overcome some of the limitations associated with measurement of tissue partial oxygen tension (PO 2 ). We compared this technique with a polarographic Eppendorf needle electrode method using a saline tonometer in which the PO 2 could be controlled. We also tested the fluorescence quenching system in a rodent model of skeletal muscle ischemia-hypoxia. Results Both systems measured PO 2 accurately in the tonometer, and there was excellent correlation between them (r 2 = 0.99). The polarographic system exhibited proportional bias that was not evident with the fluorescence method. In vivo, the fluorescence quenching technique provided a readily recordable signal that varied as expected. Discussion Measurement of tissue PO 2 using fluorescence quenching is at least as accurate as measurement using the Eppendorf needle electrode in vitro, and may prove useful in vivo for assessment of tissue oxygenation.
Limbic and frontal structures are largely implicated in panic disorder (PD). Decreased coherence imaging values, as determined by magnetoencephalography (MEG), are suggestive of decreased or inefficient communication among these structures. We have previously demonstrated that coherence source imaging (CSI) values could be similar or higher in some PD patients. The purpose of the current investigation was to replicate these finding in a larger sample. Nine strictly diagnosed PD patients and nine age-matched and sex-matched healthy controls were examined. The CSI-MEG values of 26 frontotemporal regions (FTRs) and 28 extra-frontotemporal regions (ex-FTR; Brodmann areas) were determined for each participant. MEG scans were acquired using a 151-channel whole-head biomagnetometer system. Despite the relatively small sample size, CSI values were significantly lower in a number of FTRs in PD patients. In none of the ex-FTRs (i.e. posterior regions) were there differences between panic and control groups. The above data add to the complexity of understanding the nature of the pathophysiology of PD. Our finding of decreased focal coherence imaging values may reflect decreased excitability in these areas. The preliminary finding could be interpreted as an inhibitory process guarding against the spread of activity in closer hyperexcitable areas as seen in epilepsy. The current data provide evidence for dysfunctional communication within the frontotemporal structures. The findings have implications for the understanding of the neural circuitry underlying PD.
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